Impact of Consumer Health Informatics Applications

Evidence Report/Technology Assessment
Number 188
Impact of Consumer Health Informatics Applications

Prepared for:
Agency for Healthcare Research and Quality
U.S. Department of Health and Human Services
http://www.ahrq.gov
Contract No. HHSA 290-2007-120061-I

Task Order No. 5
Prepared by:
The Johns Hopkins University Evidence-based Practice Center
Investigators
M. Christopher Gibbons, M.D., M.P.H.
Renee F. Wilson, M.S.
Lipika Samal, M.D.
Christoph U. Lehmann, M.D.
Kay Dickersin, M.A., Ph.D.
Harold P. Lehmann, M.D., Ph.D.
Hanan Aboumatar, M.D.
Joseph Finkelstein, M.D., Ph.D.
Erica Shelton, M.D.
Ritu Sharma, B.S.
Eric B. Bass, M.D., M.P.H.
AHRQ Publication No. 09(10)-E019

October 2009
This document is in the public domain and may be used and reprinted without permission except
those copyrighted materials noted for which further reproduction is prohibited without the
specific permission of copyright holders.
Suggested Citation:
Gibbons MC, Wilson RF, Samal L, Lehmann CU, Dickersin K, Lehmann HP, Aboumatar H,
Finkelstein J, Shelton E, Sharma R, Bass EB. Impact of Consumer Health Informatics
Applications. Evidence Report/Technology Assessment No. 188. (Prepared by Johns Hopkins
University Evidence-based Practice Center under contract No. HHSA 290-2007-10061-I).
AHRQ Publication No. 09(10)-E019. Rockville, MD. Agency for Healthcare Research and
Quality. October 2009.
No investigators have any affiliations or financial involvement (e.g., employment,

consultancies, honoraria, stock options, expert testimony, grants or patents received or
pending, or royalties) that conflict with material presented in this report.
ii
Preface
The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based
Practice Centers (EPCs), sponsors the development of evidence reports and technology
assessments to assist public- and private-sector organizations in their efforts to improve the
quality of health care in the United States. The EPCs systematically review the relevant scientific
literature on topics assigned to them by AHRQ and conduct additional analyses when
appropriate prior to developing their reports and assessments.
To bring the broadest range of experts into the development of evidence reports and health
technology assessments, AHRQ encourages the EPCs to form partnerships and enter into
collaborations with other medical and research organizations. The EPCs work with these partner
organizations to ensure that the evidence reports and technology assessments they produce will
become building blocks for health care quality improvement projects throughout the Nation. The
reports undergo peer review prior to their release.
AHRQ expects that the EPC evidence reports and technology assessments will inform
individual health plans, providers, and purchasers as well as the health care system as a whole by
providing important information to help improve health care quality.
We welcome comments on this evidence report. They may be sent by mail to the Task Order
Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road,
Rockville, MD 20850, or by e-mail to epc@ahrq.gov.
Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H.

Director Director, Center for Outcomes and Evidence
Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality
Beth A. Collins Sharp, R.N., Ph.D. Teresa Zayas-Cabán, Ph.D.

Director, EPC Program Task Order Officer, Center for Primary Care,
Agency for Healthcare Research and Quality Prevention, and Clinical Partnerships
Agency for Healthcare Research and Quality
iii
Acknowledgments
The EPC thanks Dr. Hosne Begum, Dr. Olaide Odelola, Dr. Christine Chang, Beth Barnett, Todd
Noletto, and Rebecca Stainman for their assistance with the final assembly and formatting of this
report, and Dr. Teresa Zayas-Cabán for her valuable insight throughout the project.
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Structured Abstract
Objective. The objective of the report is to review the evidence on the impact of consumer health
informatics (CHI) applications on health outcomes, to identify the knowledge gaps and to make
recommendations for future research.
Data sources. We searched MEDLINE®, EMBASE®, The Cochrane Library, ScopusTM, and
CINAHL® databases, references in eligible articles and the table of contents of selected journals;
and query of experts.
Methods. Paired reviewers reviewed citations to identify randomized controlled trials (RCTs) of
the impact of CHI applications, and all studies that addressed barriers to use of CHI applications.
All studies were independently assessed for quality. All data was abstracted, graded, and reviewed
by 2 different reviewers.
Results. One hundred forty-six eligible articles were identified including 121 RCTs. Studies were
very heterogeous and of variable quality.
Four of five asthma care studies found significant positive impact of a CHI application on at
least one healthcare process measure.
In terms of the impact of CHI on intermediate health outcomes, significant positive impact was
demonstrated in at least one intermediate health outcome of; all three identified breast cancer
studies, 89 percent of 32 diet, exercise, physical activity, not obesity studies, all 7 alcohol abuse
studies, 58 percent of 19 smoking cessation studies, 40 percent of 12 obesity studies, all 7 diabetes
studies, 88 percent of 8 mental health studies, 25 percent of 4 asthma/COPD studies, and one of two
menopause/HRT utilization studies. Thirteen additional single studies were identified and each
found evidence of significant impact of a CHI application on one or more intermediate outcomes.
Eight studies evaluated the effect of CHI on the doctor patient relationship. Five of these studies
demonstrated significant positive impact of CHI on at least one aspect of the doctor patient
relationship.
In terms of the impact of CHI on clinical outcomes, significant positive impact was
demonstrated in at least one clinical outcome of; one of three breast cancer studies, four of five diet,
exercise, or physical activity studies, all seven mental health studies, all three identified diabetes
studies. No studies included in this review found any evidence of consumer harm attributable to a
CHI application.
Evidence was insufficient to determine the economic impact of CHI applications.
Conclusions: Despite study heterogeneity, quality variability, and some data paucity, available
literature suggests that select CHI applications may effectively engage consumers, enhance
traditional clinical interventions, and improve both intermediate and clinical health outcomes.
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Contents
Executive Summary .........................................................................................................................1
Evidence Report ...........................................................................................................................11
Chapter 1. Introduction .................................................................................................................13

Consumer Health Informatics ..................................................................................................13
Purpose of Evidence Report.....................................................................................................14
Chapter 2. Methods........................................................................................................................15
Recruitment of Technical Experts and Peer Reviewers...........................................................15
Key Questions..........................................................................................................................15
Conceptual Framework............................................................................................................16
Literature Search Methods.......................................................................................................16
Sources...............................................................................................................................18
Search terms and strategies................................................................................................18
Organization and tracking of the literature search.............................................................18
Title Review.............................................................................................................................18
Abstract Review.......................................................................................................................19
Article Review .........................................................................................................................19
Data Abstraction ......................................................................................................................19
Quality Assessment..................................................................................................................20
Data Synthesis..........................................................................................................................20
Data Entry and Quality Control ...............................................................................................20
Grading of the Evidence ..........................................................................................................21
Peer Review .............................................................................................................................21
Chapter 3. Results ..........................................................................................................................23

Results of the Literature Search...............................................................................................23
Description of Types of Studies Retrieved ..............................................................................25
Key Question 1a: What evidence exists that consumer health informatics applications
impact health care process outcomes? ...............................................................................25
Summary of the findings....................................................................................................25
Strengths and limitations of the evidence ..........................................................................25
General study characteristics .............................................................................................25
Outcomes ...........................................................................................................................26
Key Question 1b: What evidence exists that consumer health informatics applications
impact intermediate outcomes?..........................................................................................28
Breast Cancer ........................................................................................................................28
Outcomes ...........................................................................................................................30
Diet, Exercise, Physical Activity, not Obesity......................................................................30
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Outcomes ...........................................................................................................................37
Alcohol Abuse and Smoking Cessation................................................................................41
Outcomes ...........................................................................................................................44
Obesity ..................................................................................................................................48
Outcomes ...........................................................................................................................52
Diabetes.................................................................................................................................54
Outcomes ...........................................................................................................................56
Mental Health........................................................................................................................57
Outcomes ...........................................................................................................................60
Asthma and Chronic Obstructive Pulmonary Disease..........................................................61
Outcomes ...........................................................................................................................62
Miscellaneous Intermediate Outcomes .................................................................................65
Outcomes ...........................................................................................................................66
Key Question 1c: What evidence exists that consumer health informatics applications
impact relationship-centered outcomes?............................................................................68
Outcomes ...........................................................................................................................70
Key Question 1d: What evidence exists that consumer health informatics applications
impact clinical outcomes?..................................................................................................72
Breast Cancer ........................................................................................................................72
Outcomes ...........................................................................................................................73
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Diabetes Mellitus ..................................................................................................................74
Outcomes ...........................................................................................................................75
Diet, Exercise, Physical Activity, no Obesity.......................................................................76
Outcomes ...........................................................................................................................76
Mental Health........................................................................................................................79
Outcomes ...........................................................................................................................81
Miscellaneous Outcomes ......................................................................................................83
Outcomes ...........................................................................................................................83
Key Question 1e: What evidence exists that consumer health informatics applications
impact economic outcomes? ..............................................................................................87
Outcomes ...........................................................................................................................88
Key Question 2: What are the barriers that clinicians, developers, and consumers and
their families or caregivers encounter that limit implementation of consumer health
informatics applications? ...................................................................................................88
Disease/Problem Domain...................................................................................................88
Methodology ......................................................................................................................89
Barriers...............................................................................................................................90
Key Question 3. What knowledge or evidence deficits exist regarding needed information
to support estimates of cost, benefit, and net value with regard to consumer health
informatics applications? ...................................................................................................92
Patient-related questions ....................................................................................................92
CHI utilization-related factors ...........................................................................................93
Technology/hardware/software/platform-related issues....................................................93
Health-related factors.........................................................................................................94
Key Question 4: What critical information regarding the impact of consumer health
informatics applications is needed in order to give consumers, their families, clinicians,
and developers a clear understanding of the value proposition particular to them? ..........94
Clinician and provider value proposition information needs.............................................95
Patient, family, and caregiver value proposition information needs .................................95
Research in Progress ................................................................................................................95
Chapter 4. Discussion ....................................................................................................................97

Summary of Key Findings .......................................................................................................97
Limitations ...............................................................................................................................98
Future Research Needs ............................................................................................................98
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Implications............................................................................................................................100
References and Included Studies .................................................................................................103
Figures
Figure 1. Conceptual model addressing Key Questions 1 and 2: Impact of CHI on health and
process outcomes, and barriers to use of CHI....................................................................17
Figure 2. Summary of the literature search (number of articles).............................................24
Summary Tables
Table 1. Summary of studies of CHI applications impacting health care process
outcomes (N=5) .................................................................................................................26
Table 2. Grade of the body of evidence addressing CHI impact on health care processes in
asthma ................................................................................................................................27
Table 3. Results of studies of CHI applications impacting intermediate outcomes in breast
cancer (N=3) ......................................................................................................................29
Table 4. Grade of the body of evidence addressing CHI impact on intermediate outcomes
in breast cancer ..................................................................................................................29
Table 5. Results of studies on CHI applications impacting intermediate outcomes in diet,
exercise, or physical activity, not obesity (N=32). ............................................................31
Table 6. Grade of the body of evidence addressing CHI impacts on intermediate outcomes
in diet, exercise, nutrition intervention (not obesity).........................................................36
Table 7. Results of studies on CHI applications impacting intermediate outcomes in
alcohol abuse and smoking (N=26) ...................................................................................42
in alcohol abuse and smoking ............................................................................................44
Table 9. Results of studies on CHI applications impacting intermediate outcomes related
to obesity (N=11) ...............................................................................................................50
in obesity............................................................................................................................52
diabetes (N=7)....................................................................................................................55
in diabetes ..........................................................................................................................56
Table 13. Results of studies on CHI applications impacting intermediate outcomes of
mental health (N=8). ..........................................................................................................58
in mental health..................................................................................................................59
asthma and COPD (N=4) ...................................................................................................63
in asthma/COPD ................................................................................................................64
Table 17. Studies of CHI applications impacting relationship-centered outcomes in women
with breast cancer (N=4)....................................................................................................69
Table 18. Grade of the body of evidence addressing CHI impact on relationship-centered
outcomes in breast cancer ..................................................................................................70
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Table 19: Results of studies on CHI applications impacting relationship-centered outcomes
in breast cancer (N=4)........................................................................................................71
Table 20: Results of studies on CHI applications impacting clinical outcomes in breast
cancer (N=3) ......................................................................................................................72
Table 21. Grade of the body of evidence addressing CHI impact on clinical outcomes in
individuals with breast cancer............................................................................................74
Table 22. Results of studies on CHI applications impacting clinical outcomes in diabetes
mellitus (N=3).....................................................................................................................75
individuals with diabetes mellitus......................................................................................75
Table 23. Results of studies on CHI applications impacting clinical outcomes in diet,
exercise, physical activity, not obesity (N=5)....................................................................77
Table 24. Grade of the body of evidence addressing CHI impact on clinical outcomes
related to diet, exercise, or physical activity, not obesity .................................................78
Table 25. Results of studies on CHI applications impacting clinical outcomes in mental
health (N=7) .......................................................................................................................80
mental health......................................................................................................................81
Table 27. Studies of CHI applications impacting miscellaneous clinical outcomes (N=10)...84
Table 28. Studies of CHI applications impacting economic outcomes (N=3) ........................87
Table 29. The distribution of methodologies for identifying barriers to the use of
consumer health informatics by disease /problem domain ................................................90
Table 30. The distribution of methodology by barrier type.....................................................90
Table 31. The distribution of barrier levels by disease/problem domain ................................91
Appendixes
Appendix A: List of Acronyms
Appendix B: Technical Experts and Peer Reviewers
Appendix C: Detailed Search Strategies
Appendix D: Grey Literature Detailed Search Strategies
Appendix E: Screen and Data Abstraction Forms
Appendix F: Excluded Articles
Appendix G: Evidence Tables
Appendixes and Evidence Tables for this report are provided electronically at
http://www.ahrq.gov/clinic/tp/chiapptp.htm.
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Executive Summary
Many people are excited about the potential to improve the health of the public by using
health information technology (health IT) and eHealth solutions that are tailored to consumers.
Despite growing interest in this field referred to as consumer health informatics (CHI), the value
of CHI applications has not been rigorously reviewed. The objectives of this report were to
review the literature on the evidence of the influence of currently developed CHI applications on
health and health care process outcomes, to identify the gaps in the CHI literature, and to make
recommendations for future CHI research. For the purposes of this review, CHI is defined as any
electronic tool, technology, or electronic application that is designed to interact directly with
consumers, with or without the presence of a health care professional that provides or uses
individualized (personal) information and provides the consumer with individualized assistance,
to help the patient better manage their health or health care.
The specific Key Questions were:
1. What evidence exists that CHI applications impact:

a. Health care process outcomes (e.g., receiving appropriate treatment) among users?
b. Intermediate health outcomes (e.g., self-management, health knowledge, and health
behaviors) among users?
c. Relationship-centered outcomes (e.g., shared decisionmaking or clinician-patient
communication) among users?
d. Clinical outcomes (including quality of life) among users?
e. Economic outcomes (e.g., cost and access to care) among users?
2. What are the barriers that clinicians, developers, consumers, and their families or
caregivers encounter that limit utilization or implementation of CHI applications?
3. What knowledge or evidence exists to support estimates of cost, benefit, and net value
with regard to CHI applications?
4. What critical information regarding the impact of CHI applications is needed to give
consumers, their families, clinicians, and developers a clear understanding of the value
proposition particular to them?
The best evidence available to answer Key Question 1 is found in randomized controlled
trials (RCTs). However, RCTs are not the best study design for addressing Key Question 2, so
for this question we included articles on any study that was designed to look at barriers to use of
CHI, including but not limited to the RCTs that addressed Key Question 1. Key Question 3
addressed knowledge and evidence deficits regarding needed information to support the
estimation of costs, benefits, and value regarding CHI applications. Key Question 4 addresses
critical information regarding the effect of CHI applications needed to give consumers, their
families, clinicians, and developers a clear understanding of the value of CHI applications.
To identify articles that addressed Key Question 1, we searched computerized literature
databases using terms relevant to our definition of CHI applications, combined with terms
relevant to our definition of “consumer,” combined with terms identifying RCTs as the study
design of interest. To search for articles that were relevant to Key Question 2, we used terms
relevant to our definition of CHI applications, combined with terms relevant to barriers; the
search was not limited by study design. Our comprehensive search included electronic searching
1
of MEDLINE®, EMBASE®, The Cochrane Library, ScopusTM, and CINAHL® databases. We
also looked for eligible studies by reviewing the references in pertinent reviews, by querying our
experts, and by searching grey literature sources such as conference proceedings.
Studies were eligible for inclusion in the review if they applied to Key Question 1 or 2 and
did not have one of the following reasons for exclusion: no health informatics application, health
informatics application does not apply to the consumer, health informatics applications is for
general information only (e.g., general Web site) and is not tailored to individual consumers,
study of a “point of care” device (defined as requiring a clinician to use or obtain and is part of
the regular provision of care), or no original data.
We assessed the eligible studies on the basis of the quality of their reporting of relevant data.
For the RCTs, we used the study quality scoring system developed by Jadad et al. For the other
studies, we used a form to identify key elements that should be reported when reporting results.
The quality assessments were done independently by paired reviewers.
We then created a set of detailed evidence tables containing information extracted from the
eligible studies. We stratified the tables according to the applicable Key Question and
subquestion (for Key Question 1). We did not quantitatively pool the data for any of the
outcomes because of the marked heterogeneity of target conditions of interest and the wide
variety of outcomes studied.
Data were abstracted by one investigator and entered into online data abstraction forms using
SRS (Mobius Analytics, Inc., Ottawa, Ontario, CA) Second reviewers were generally more
experienced members of the research team, and one of their main priorities was to check the
quality and consistency of the first reviewers’ answers.
At the completion of our review, we graded the quantity, quality, and consistency of the best
available evidence for each type of outcome in each clinical area, using an evidence grading
scheme recommended by the GRADE Working Group and modified for use by the Evidence-
based Practice Centers (EPC) Program. For each outcome of interest, two investigators
independently assigned a grade, and then the entire team discussed their recommendations and
reached a consensus.
Throughout the project, the core team sought feedback from external experts with expertise
in systematic reviews, CHI, consumer advocacy, decision aids, and ethics. A draft of the report
was sent to the external experts. The EPC team addressed the comments of the external experts
before submitting the final version of the evidence report.
Results
Our literature search identified 146 articles that were eligible for inclusion in this report: 121
for Key Question 1 and 31 for Key Question 2; 6 articles were eligible for both Key Question 1
and Key Question 2. All of the Key Question 1 eligible studies were RCTs. The 31 articles
addressing barriers to use of CHI applications fell under a variety of study designs and data
collection types. Data on barriers was collected mostly in non-validated surveys and qualitative
studies from trial data.
In terms of types of applications studied, 55 percent of studies evaluated interactive Web-
site–based applications or Web-based tailored educational Web sites. Another 15 percent of
studies evaluated computer-generated tailored feedback applications. Interactive computer
programs and personal monitoring devices were evaluated in approximately 8 percent of studies
each. Finally, health risk assessments, decision aids, cell phones, laptops, CD ROMs, personal
2
digital assistants (PDA/smartphones), short message system texting (SMS/text), discussion/chat
groups and computer-assisted imagery were evaluated in less than 5 percent of studies each. In
terms of participant age groups, 77 percent (76/99) of studies reporting age of participants
targeted adult CHI users. Approximately 12 percent of studies targeted adolescents/teens, 3
percent of studies targeted seniors and another 3 percent of studies targeted children. Five
percent of studies targeted participants from overlapping age groups. In terms of intervention
delivery setting or location, 58 percent of studies reporting delivery location evaluated CHI
applications that were used in the home or residence. A minority of evaluations were completed
in schools (15 percent), clinical settings (17 percent), communities (3 percent), online (5 percent)
or kiosks (2 percent). Finally, of studies reporting the race of the participants 92 percent (49/53)
of the studies employed populations that were greater than 50 percent white/Caucasian. There
was only one study with greater than 50 percent African-American participants and no studies
with a majority of participants who were Hispanic, American Indian/Alaska Native, or
Asian/Pacific Islander.
Key Question 1: What is the evidence of impact of CHI applications

on health outcomes?
First, we sought to understand the impact of CHI applications on health care process
outcomes (Key Question 1a). There were only five studies that met the inclusion-exclusion
criteria and thus were available to shed light on this question. Five of these studies focused on
asthma and one additional study focused on contraceptive medication utilization. All of the
asthma studies showed a significant positive effect of the CHI application on at least one health
care process measure. The oral contraceptive medication use application failed to reduce
contraceptive discontinuation. No study found any evidence of harm.
This review identified 108 studies that addressed the influence of CHI applications on
intermediate health outcomes (Key Question 1b). These 108 studies evaluated the effects of CHI
applications on intermediate outcomes in the context of nine categories of diseases or health
conditions. Intermediate outcomes were evaluated related to breast cancer in three studies, diet,
exercise, physical activity, not obesity in 32 studies, alcohol abuse in seven studies, smoking
cessation in 19 studies, and obesity in 11 studies, diabetes mellitus (or diabetes with associated
conditions) in seven studies, mental health in eight studies, asthma/chronic obstructive
pulmonary disease (COPD) in four studies, and miscellaneous health conditions in another 15
studies.
With regard to breast cancer, evaluated intermediate outcomes included social support,
information competence, level of conflict, and satisfaction. All three studies reported significant
positive effect on at least one intermediate health outcome. No study found any evidence of
harm.
In terms of diet, exercise, physical activity, not obesity, evaluated intermediate outcomes
included self-management, knowledge, program adherence, and change in health behaviors.
Eighty-nine percent of these studies demonstrated significant positive effect on at least one
intermediate health outcome related to diet, exercise, and physical activity. No study found any
evidence of harm.
Evaluated intermediate outcomes related to alcohol abuse included self-management,
knowledge attainment, and change in health behaviors. All studies found significant positive
3
effect on at least one intermediate outcome related to alcohol abuse. No study found any
evidence of harm.
With regard to smoking cessation, intermediate outcomes assed in these smoking cessation
CHI trials included self-management, knowledge attainment, and change in health behaviors.
Fifty-seven percent of these studies demonstrated a positive effect on at least one intermediate
outcome related to smoking cessation. No study found any evidence of harm.
Evaluated intermediate outcomes of interest related to obesity included weight loss behaviors
and body composition. Only 36 percent of studies demonstrated positive effect on intermediate
outcomes related to obesity. No study found any evidence of harm.
Seven studies were identified to evaluate the influence of CHI on intermediate outcomes
related to diabetes mellitus. Intermediate outcomes of interest included perceived self- efficacy,
satisfaction, and readiness to change, perceived competence, exercise minutes per day, and self-
reported global health. All seven studies found evidence of effect of CHI applications on one or
more intermediate outcomes related to diabetes mellitus. No study found any evidence of harm.
Eight studies were identified to evaluate the effect of CHI applications on intermediate
outcomes related to mental health issues. Intermediate outcomes of interest included work and
social adjustment, perceived stress, self-rated self-management, sleep quality, mental energy, and
concentration. Seven of the eight studies found evidence of positive effect of CHI applications
on at one or more intermediate outcomes related to mental health. No study found any evidence
of harm.
Four studies were identified to evaluate the effect of CHI applications on intermediate
outcomes related to asthma/COPD. Intermediate outcomes of interest included adherence,
knowledge, change in behavior, dyspnea knowledge, and self-efficacy. Only one of the four
studies demonstrated a significant effect on any intermediate outcome related to asthma/COPD.
No study found any evidence of harm.
Two studies were identified to evaluate the effect of CHI applications on intermediate
outcomes related to menopause or hormone replacement therapy (HRT). Only one study found
evidence of significant effect on an intermediate outcome related to menopause/HRT utilization.
Finally, an additional 15 studies were identified to evaluate the influence of intermediate
health outcomes in other clinical areas. These intermediate outcomes were in health areas related
to arthritis, back pain, behavioral risk factor control, contraception, cardiovascular disease,
cancer, caregiver decisionmaking, fall prevention, health behavior change, headache, HIV/AIDS,
and adolescent risk behaviors. Each of these studies found evidence of significant effect of the
CHI application on intermediate outcomes related to the health condition under study. No study
found evidence of harm.
Another subquestion of this key question this review sought to answer was regarding the
effect of CHI applications on relationship centered outcomes (Key Question 1c). Eight studies
were identified that met the inclusion-exclusion criteria. Relationship centered outcomes of
interest included social support, quality of life, decisionmaking skill, social support, positive
interaction with the provider, and satisfaction with care. These relationship centered outcomes
were evaluated in the context of HIV/AIDS, cancer, osteoarthritis, and pregnancy. Just over 60
percent (5/8) of studies demonstrated significant effect of CHI on at least one aspect of
relationship centered care. No study found any evidence of harm.
Twenty-eight studies addressed the question about the impact of CHI applications on clinical
outcomes (Key Question 1d). Clinical outcomes evaluated in the identified studies included
disease-specific outcomes in the context of cancer (three studies), diabetes mellitus (three
4
studies), mental health (seven studies), diet, exercise, or physical activity (five studies), and
Alzheimer’s disease, arthritis, asthma, back pain, aphasia, COPD, HIV/AIDS, headache, obesity,
and pain (one study each). Over 80 percent of studies found significant influence of CHI
applications on at least one clinical outcome. Three studies evaluated the effect of CHI
applications on breast cancer clinical outcomes, but only one found any evidence of significant
CHI impact. Of the five studies that evaluated the effect of CHI applications on clinical
outcomes related to diet, exercise or physical activity, four studies found a significant positive
effect on one or more clinical outcomes. Among the seven studies that evaluated the effect of
CHI applications on mental health clinical outcomes, all seven found evidence of significant
effect of CHI on one or more clinical outcomes. Three studies evaluated the effect of CHI
applications on diabetes mellitus clinical outcomes. All three studies found evidence of
significant effect of CHI on at least one clinical outcome. The remaining nine studies evaluated a
CHI application in different health areas including Alzheimer’s disease, arthritis, asthma, back
pain, aphasia, COPD, headache, HIV/AIDS, and general pain. With the exception of the general
pain study, the eight remaining studies all found evidence of significant effect of CHI on one or
more clinical outcomes. None of these 27 studies found any evidence of harm attributable to a
CHI application.
The fifth subquestion of this key question was about the evidence of impact of CHI
applications on economic outcomes (Key Question 1e). Three studies addressed this question.
Economic outcomes evaluated in these studies included cost of program delivery, cost of
computer information system with manual data extraction versus cost of the computer system
with use of the electronic patient record, materials costs, total costs, and incremental cost-
effectiveness. These outcomes were evaluated in the context of asthma, cancer, and obesity.
Each of these studies used different economic metrics and methodologies. One study failed to
provide any cost estimates for the control group. One study was done in an adult population,
another in a pediatric population, and the third study did not provide any details regarding the
age of study participants. Given the very small number of studies and the significant limitations
and heterogeneity of these studies, no conclusions regarding the economic impact of CHI
applications can be made.
Key Question 2: What are the barriers that clinicians, developers,

consumers, and their families or caregivers encounter that limit
utilization or implementation of CHI applications?
Thirty-one studies addressed the barriers to CHI applications. Studies focused on a wide
variety of clinical conditions including cancer, HIV/AIDS (and sexually transmitted disease),
mental health, physical activity/diet/obesity, smoking cessation, prostate cancer, and
hypertension. The methodology used to identify barriers included validated and nonvalidated
surveys, and qualitative and empirical research. Because CHI applications involve the
participation of consumers, their caregivers, clinicians, and often developers, barriers can apply
to any of the participants and the type and impact of the barrier may vary significantly between
providers, developers, patients, and their caregivers. Thus, this analysis of the barriers included
barriers that impede participation of any of the above groups.
In terms of systems-level barriers, six studies addressed Internet access at home or in the
community and six found this to be a barrier. One study identified hardware requirements and
5
another study identified mobile device shape/design/configuration as a systems-level barrier.
Another five studies cited incompatibility with current health care as a barrier.
Identified individual-level barriers included clinic staff who feared increased workloads, lack
of built-in social support, forgotten passwords, automated data entry inability to allow for back
entry of old data, lack of adequate user customization, and substantial financial investment.
Nineteen studies queried application usability or user-friendliness and all 19 found evidence of
this barrier. Eleven studies explored patient knowledge, literacy, and skills to use the CHI
application. All found these deficits to be barriers while one study found no evidence that
literacy or knowledge deficits were a barrier. Six studies considered the possibility that users
would find the application too time-consuming and five of these studies cited the evidence in the
results section, while the one additional study cited too many emails to participants as a barrier.
Utilization fees were also identified as a barrier. Five studies sought information about privacy
concerns and four reported concerns over privacy as a barrier. These studies also found concerns
over the control of information or lack of trust to be barriers. Only two studies queried for
potential cultural barriers and one study found evidence of this. The expectations of consumers
including acceptability, usefulness, credibility, expectations, and goals were found to be barriers
in eight studies. Cost was mentioned as a barrier in only one study and only one study found
evidence that physical or cognitive impairment resulted in barriers to the use of CHI
applications. Finally, anxiety over the use of computers, complaints about lack of personal
contact with clinicians and the belief that health IT would not be an improvement to current care
were mentioned in two studies as barriers.
Key Question 3: What knowledge or evidence deficits exist regarding

needed information to support estimates of cost, benefit, and net
value with regard to consumer health informatics applications?
The literature was at a very early stage of development. Many questions have only been
evaluated by one study. Thus, confirmatory studies have generally not been done. In addition, no
high quality studies have been conducted regarding several important questions. Broadly, these
questions can be grouped into at least one of four categories: patient-related questions; CHI
utilization factors; technology-related issues (i.e., hardware, software, and platform related
issues, and health-related questions).
Patient-related questions. The literature is relatively silent on the question of whether or not
significant differences in patient preferences, knowledge, attitudes, beliefs, needs, utilization and
potential benefits exists across gender, age and race/ethnicity. The same could be said for
potential gender and race or ethnicity-based differences. Beyond these demographic differences,
the field of CHI is developing within the context of a global emergence of technology based
realities including Web 2.0/Web 3.0 and ubiquitous computing which are enabling an
unprecedented level of user determined interactivity and functionality. The degree to which this
functionality could be harnessed for the health benefit of consumers is unknown. The targeted
uses of CHI applications must increasingly be focused on more than just the index patient. The
role of sociocultural and community factors will likely exert significant effect on access,
usability, desirability and benefit of CHI applications. Issues related to trust, security,
confidentiality need to be further explored. Because the bulk of the currently available research
has been conducted on the 18-to 65-year-old adult population, more work needs to be done
among the populations that may have the most potential for using CHI applications. Seniors may
6
stand to benefit from those applications that reduce social isolation and independence.
Adolescents are some of the most intense technology users. Their natural affinity for technology
may prove advantageous to CHI applications that could be developed in the future. Finally, most
of the currently CHI research is being conducted among predominately white/Caucasian
populations. Early evidence suggests that differential utilization patterns and preferences exist by
race. Such differences could potentially lead to differential efficacy of emerging CHI
applications. This could have the unintended consequence of enhancing rather than reducing
some racial and ethnic disparities in health care. Age and race/ethnicity subgroup differences
need to be netter understood and those differences incorporated into the development of
emerging applications to ensure efficacy among all population subgroups.
CHI utilization factors. Despite a rapid increase in access to broadband services among all
population groups, age groups and geographic regions of the country, differential access to
broadband internet access may have significant implications in terms of health benefits that may
be derived from these tools and applications. While many in the younger generations become
very technically savvy at an early age, many Americans still have limited health literacy. These
CHI utilization factors suggest the need for a more robust evaluation of the epidemiology of
broadband access and technology literacy in the United States.
Technology-related issues. The majority of CHI applications are designed for use on
personal computers as Web-based applications. Many more potential platforms exist that have
not been evaluated. In addition, emerging evidence is suggesting that the CHI applications and
functionality that consumers want and need are not always what health care practitioners think
they need. As a result, important sociocultural and human computer interface design elements
may not get incorporated adequately into emerging CHI applications and therefore lead to CHI
applications with limited efficacy.
Health-related questions. Finally, most CHI applications that have been evaluated tend to
focus on one or more domains of chronic disease management. Insufficient attention has been
given to the role of CHI applications in addressing acute health problems. The role of CHI
applications in primary, secondary, and tertiary prevention also needs to be more adequately
explored. Sociocultural factors are increasingly important determinants of health care outcomes.
The potential influence on social factors including social isolation and social support and perhaps
even broader social determinants of health need to be evaluated and may prove useful in helping
consumers address specific health concerns in the home and community-based setting.
Key Question 4: What critical information regarding the impact of

consumer health informatics applications is needed in order to give
consumers, their families, clinicians, and developers a clear
understanding of the value proposition particular to them?
Several critical information needs must be addressed to enable a clear understanding of the
value proposition of CHI applications. It is likely that the knowledge gaps needed to establish a
value proposition, while overlapping, are not identical across all potential stakeholders. Because
providers are often most concerned about clinical outcomes and costs, it seems reasonable that
questions of the impact of CHI applications on provider or health care processes, costs, and
outcomes as addressed in this report will need to be more definitively characterized. In addition,
the potential liability a provider might incur from a patient using a CHI application will also need
to be addressed.
7
Patients often cite convenience and anonymity as the primary reasons the Internet has
become such a major source of health information. It is likely that the more these elements can
be incorporated into emerging CHI applications, the more likely they will be considered of value
by consumers. Other related factors such as usability, portability, and patient-centered
functionality are likely important characteristics of CHI applications that may help drive
utilization. Those technologies that exist and enable consumers to accomplish tasks (empower)
without further complicating individuals’ lives may ultimately prove to be the most widely
valued CHI applications. By expanding the number of platforms available to consumers, CHI
applications may become more appealing to a broader consumer base and thus prove valuable to
those consumers who could most benefit, but may not otherwise use a more traditional CHI
application.
Discussion
Overall, despite the significant heterogeneity and limited nature of the literature, the
following themes were suggested by the studies included in this review. First, there may be a role
for CHI applications to reach consumers at a low cost and obviate the need for some activities
currently performed by humans. In addition, the data suggest that CHI applications may also be
used to enhance the efficacy of interventions currently delivered by humans. Several studies
compared the use of a CHI application and traditional therapy against traditional therapy alone.
Many found that the group receiving traditional therapy with a CHI application had more benefit
than traditional therapy alone. Thirdly, the studies evaluated in this review tended to support the
finding that at least three critical elements are most often found in those CHI applications found
to exert a significant effect on health outcomes. These three factors are (1) individual tailoring,
(2) personalization, and (3) behavioral feedback. Personalization involves designing the
intervention to be delivered in a way that makes it specific for a given individual. Tailoring
refers to building an intervention in part on specific knowledge of actual characteristics of the
individual receiving the intervention. Finally, behavioral feedback refers to providing consumers
with messages regarding their progression through the intervention. Interestingly, it is not clear
from this literature that CHI-derived behavioral feedback is any better than feedback originating
from human practitioners or others. Rather, it appears that the feedback must happen with an
appropriate periodicity, in a format that is appealing and acceptable to the consumer, not just the
provider.
Finally, despite the paucity of studies in many areas of this emerging field and because of the
methodological limitations found in many of the studies, the body of the available scientific
evidence suggests that CHI applications may hold significant future promise for improving
outcomes across a wide variety of diseases and health issues. In terms of health care processes
and relationship centered outcomes, the literature is positive but very limited. Most of the
currently available research has evaluated the impact of CHI applications on intermediate health
outcomes. Due in part to the number of studies conducted to date, the evaluation of both short-
term and longer-term outcomes, the utilization of significant sample sizes, appropriate statistics,
the near uniformity of dependent variables across studies, and cogent articulation of the theoretic
bases of the CHI content and methodology in most studies, the literature appears strongest for
CHI applications targeting intermediate outcomes related to smoking cessation. In terms of
clinical outcomes, the weight of the evidence appears strongest for the use of CHI applications
8
on mental health outcomes. Evidence-based conclusions regarding economic outcomes can not
be made at this time.
Despite the positive nature of some of the available evidence, significant research
opportunities and knowledge gaps exist in terms of understanding the role of CHI applications
targeting children, adolescents, the elderly, and specifically nontraditional (family members,
friends, allied health workers) patient caregivers. The role of Web 2.0, social networking, and
health gaming technology in CHI has not been adequately evaluated. Much more work needs to
be done to understand consumer desires and needs versus provider perceptions of patient desires
and needs in terms of emerging CHI applications and tools. Similarly, much more work is
needed to explicate the effect of CHI applications on health outcomes among racial and ethnic
minority populations, low-literate populations, and the potential effect of these applications on
health care disparities.
Finally, CHI research would be greatly enhanced with standardization and widespread
utilization of a transdisciplinary CHI nomenclature and a CHI evaluation registry to facilitate
uniform reporting and synthesis of results across emerging CHI applications, interventions, and
evaluations.
9
Evidence Report
12
Chapter 1. Introduction
Consumer Health Informatics

Interest is emerging concerning the potential of technology and eHealth solutions that are
tailored to consumers. This emerging field has been referred to as consumer health informatics
(CHI) (see Appendix A1 for a list of acronyms). It has been defined by Eysenbach as a branch of
medical informatics that “analyzes consumers’ needs for information, studies and implements
methods of making information accessible to consumers, and models and integrates consumers’
preferences into medical information systems.”1 In 2001, Houston et al2 conducted a survey of
members of the American Medical Informatics Association (AMIA) to generate a consensus
definition of CHI. Respondents indicated that CHI incorporated a broad range of topics, the most
common being patient decision support and patient access to their own health information.
Despite this growing interest, the value of CHI has not been rigorously reviewed. We will review
the evidence regarding the proposed questions, focusing on several kinds of outcomes.
For the purpose of this review, we define CHI applications as any electronic tool, technology,
or system that is: 1) primarily designed to interact with health information users or consumers
(anyone who seeks or uses health care information for nonprofessional work) and 2) interacts
directly with the consumer who provides personal health information to the CHI system and
receives personalized health information from the tool application or system; and 3) is one in
which the data, information, recommendations or other benefits provided to the consumer, may
be used with a healthcare professional, but is not dependent on a healthcare professional. As
such, for the purposes of this review, we have excluded point of care devices (e.g., glucometer,
remote monitoring devices), prescribed clinical devices that are part of the provision of clinical
care, general information websites, message boards, and applications that are designed for use in
a work environment.
This definition has the following advantages:
1) It keeps the focus of the review on how CHI applications meet the needs of consumers
rather than the needs of clinicians;
2) It helps avoid a categorical disease-oriented evaluation of every clinical technological
development for every disease which is not necessarily focused on the needs of
consumers;
3) It helps to keep the focus of the review on studies that demonstrate impact, value or
efficacy from the perspective of consumers;
4) It facilitates categorization of CHI applications in ways that may be more meaningful for
patients.
Potential categories of CHI tools/technologies/applications include but may not be limited to:
a. Applications and technologies that facilitate knowing/tracking/understanding clinical
parameters (disease management);
b. Applications and technologies that facilitate knowing/tracking/understanding observations
of daily living (ODL’s);
c. Applications and technologies that facilitate calendaring (lifestyle management assistance);
d. Applications and technologies that facilitate prevention and health promotion;
1
Appendixes and evidence tables cited in this report are available at: http://www.ahrq.gov/clinic/tp/chiapptp.htm.
13
e. Applications and technologies that facilitate self-care; and
f. Applications and technologies that facilitate assisted care and caregiving.
Purpose of Evidence Report
The objective of the report is to review the literature on the evidence of the impact of
currently developed CHI applications on health and health care process outcomes, to identify the
gaps in the literature, and to recommend future research endeavors to better assess these
information technology (IT) applications. The specific Key Questions were:
1. What evidence exists that CHI applications impact:
a. Health care process outcomes (e.g., receiving appropriate treatment) among users?
b. Intermediate health outcomes (e.g., self management, health knowledge, and health
behaviors) among users?
c. Relationship-centered outcomes (e.g., shared decision making or clinician-patient
communication) among users?
d. Clinical outcomes (including quality of life) among users?
e. Economic outcomes (e.g., cost and access to care) among users?
2. What are the barriers that clinicians, developers and consumers and their families or
caregivers encounter that limit utilization or implementation of CHI applications?
3. What knowledge or evidence exists to support estimates of cost, benefit, and net value
with regard to CHI applications?
4. What critical information regarding the impact of CHI applications is needed in order to
give consumers, their families, clinicians, and developers a clear understanding of the
value proposition particular to them?
We will discuss gaps in research, including specific areas that should be addressed. We also
will suggest possible public and private organizational types to perform the research and/or
analysis.
14
Chapter 2. Methods
The objective of the report is to review and synthesize the available evidence regarding the
impact of currently developed CHI applications on health and health care process outcomes. This
report will also identify barriers to the use of CHI applications. This review will help to identify
the gaps in published information on costs, benefits, and net value of these applications in
existing research on CHI applications. Additionally, we will use this report to identify what
critical information is needed for consumers, their families, clinicians, and developers to clearly
understand the value of CHI applications.
Recruitment of Technical Experts and Peer Reviewers

We assembled a core team of experts from Johns Hopkins University (JHU) who have strong
expertise in health information technology IT, including: clinical IT and health sciences IT;
clinical trials; systematic literature reviews; epidemiological studies; and general medicine. We
recruited two advisors who have done extensive research in the areas of open access, health
policy, eHeath, and CHI. We recruited seven external technical experts, referred to as a
“Technical Expert Panel” (TEP), from diverse professional backgrounds including consumer
advocates, a methods expert for another Evidence-based Practice Center (EPC), and academic
experts in ethics, decision aids, CHI, and CHI user acceptance. An additional group of two peer
reviewers was identified to provide comments on the report. Peer reviewers differed from the
TEP members in that they were not involved during the project development phase of the project
(See Appendix B1, List of Internal Advisors, Technical Experts, and Peer Reviewers).
Key Questions
The core team worked with the external advisors, technical experts, and representatives of
the Agency for Healthcare Research and Quality (AHRQ) to refine a set of key questions
originally proposed by AHRQ for this project. These Key Questions are presented in the “The
Purpose of This Evidence Report” section of Chapter 1 (Introduction). Before searching for the
relevant literature, we clarified the definitions of these Key Questions and the types of evidence
that we would include in our review.
Key Question 1 addresses the impact CHI applications have on health and health care process
outcomes. Based on conversations with AHRQ, the external advisors and the TEP, there was
agreement that the best evidence available to answer this question would be found in randomized
controlled trials (RCTs).
Key Question 2 addresses the barriers that users of a CHI application might encounter. Based
on conversations with AHRQ, the external advisors, and the TEP, we agreed that RCTs were not
the best study design to identify and evaluate barriers. We decided to include articles on any
study design whose specified purpose was to look at barriers to use of CHI. All RCTs evaluated
for Key Question 1 were reviewed to determine whether barriers were assessed as well.
Key Question 3 addresses knowledge and evidence deficits regarding needed information to
support estimation of costs, benefits, and value regarding CHI applications. Key Question 4
addresses the identification of critical information regarding the impact of CHI applications to
1
15
give consumers, their families, clinicians, and developers a clear understanding of the value of
CHI applications. There was agreement amongst the core team, external advisors, AHRQ, and
the TEP that the answers to these two questions (regarding knowledge deficits and missing
information) would emerge from our review of the evidence on Key Questions 1 and 2.
Conceptual Framework
Experts from medical informatics, public health, health services research, behavioral
sciences, human factors, and primary care were consulted to assist the EPC in the development
of a conceptual framework to address the key questions (above). During the process, we
evaluated several different types of conceptual models. We ultimately developed a model that
incorporates barriers to CHI use as well as health outcomes, health care process measures,
intermediate outcomes, relationship-centered outcomes, and economic outcomes. The barriers as
well as the health care process measures were incorporated based on the key questions presented
to us. Our purpose was to focus the model to direct our review of the relevant literature and to
assist reviewers in understanding which articles applied to our strict criteria for inclusion.
Knowing that CHI applications are being employed across the spectrum of health and illness,
we aimed to encompass activities that are not traditionally considered preventive health but are
emerging as potentially important to patient health concerns such as observations of daily living
(a personal log of activities such as sleep, diet, exercise, mood, etc.). The final framework
encompassed selected concepts of CHI applications (Figure 1).
Literature Search Methods
Searching the literature involved identifying reference sources, formulating a search strategy
for each source, and executing and documenting each search. For the searching of electronic
databases, we used medical subject heading (MeSH) terms. To identify articles that that were
potentially relevant to Key Question 1, we searched for terms relevant to our definition of CHI
applications (see Chapter 1, Introduction), combined with terms relevant to our definition of
“consumer” (see Chapter 1, Introduction), combined with terms identifying RCTs as the study
design of interest. To identify articles that that were potentially relevant to Key Question 2, we
searched for terms relevant to our definition of CHI applications (see Chapter 1, Introduction),
combined with terms relevant to barriers; the search was not limited by study design. We used a
systematic approach to searching the literature to minimize the risk of bias in selecting articles
for inclusion in the review.
We also looked for eligible studies by reviewing the references in pertinent reviews, by
querying our experts, and by taking advantage of knowledge shared at core team meetings
16
Figure 1. Conceptual model addressing Key Questions 1 and 2: Impact of CHI on health and health care process outcomes, and barriers
to use of CHI.
17
Sources
Our comprehensive search included electronic searching of peer reviewed literature
databases and grey literature databases as well as hand searching. On December 22, 2008, we ran
searches of the MEDLINE®, EMBASE®, The Cochrane Library, Scopus, and Cumulative Index
to Nursing and Allied Health Literature (CINAHL) databases. This search was updated after the
submission of the draft report to ensure we included the most current relevant articles; this search
was extended to June 1, 2009. A supplemental search targeting grey literature sources was
conducted on January 7, 2009; it was also extended to June 1, 2009. Sources searched were:
Health Services Research Projects in Progress, The Institute of Electrical and Electronics
Engineers (IEEE) Conference Proceedings, Institution of Engineering and Technology (IET)
Conference Proceeding, Proceedings of the American Society for Information Science and
Technology (Wiley InterScience), World Health Organization (WHO) –International Clinical
Trials Registry Platform, American Public Health Association (APHA) 2000-2008, OpenSIGLE
–System for Information on Grey Literature in Europe, and The New York Academy of
Medicine – Grey Literature.
Search Terms and Strategies
Search strategies specific to each database were designed to enable the team to focus the
available resources on articles that were most likely to be relevant to the Key Questions. We
developed a core strategy for MEDLINE®, accessed via PubMed, on the basis of an analysis of
the medical subject heading (MeSH) terms and text words of key articles identified a priori. The
PubMed strategy formed the basis for the strategies developed for the other electronic databases
(see Appendix C, Detailed Search Strategies; and Appendix D, Grey Literature Search
Strategies).
Organization and Tracking of the Literature Search

The results of the searches were downloaded into ProCite® version 5.0.3 (ISI ResearchSoft,
Carlsbad, CA). Duplicate articles retrieved from the multiple databases were removed prior to
initiating the review. From ProCite, the articles were uploaded to SRS 4.0 (TrialStat© 2003-
2007). SRS is a secure, Web-based collaboration and management system designed to speed the
review process and introduce better process control and scientific rigor. In February of 2009, the
SRS system was transferred to new owners, Mobius Analytics (Ottawa, Canada). Functionality
of the system was unchanged. We used this database to store full articles in portable document
format (PDF) and to track the search results at the title review, abstract review, article
inclusion/exclusion, and data abstraction levels.
Title Review
The study team scanned all the titles retrieved. Two independent reviewers conducted title
scans in a parallel fashion. For a title to be eliminated at this level, both reviewers had to indicate
that it was ineligible. If the first reviewer marked a title as eligible, it was promoted to the next
18
elimination level, or if the two reviewers did not agree on the eligibility of an article, it was
automatically promoted to the next level (see Appendix E, Title Review Form).
The title review phase was designed to capture as many studies as possible that reported on
either the impact of CHI applications on process or clinical outcomes, or on barriers to consumer
use of CHI applications. All titles that were thought to address the above criteria were promoted
to the abstract review phase.
Abstract Review
The abstract review phase was designed to identify articles that applied to Key Questions 1
and/or 2. An abstract was excluded at this level if it did not apply to one of these Key Questions
or for any of the following reasons: no health informatics application; health informatics
application does not apply to the consumer; health informatics application is for general
information only (e.g., general website, message board, survey, etc.) AND is not tailored to the
individual consumer; study of a "point of care" device (requires a clinician to use or obtain and is
part of the regular provision of care, such as a device or telemedicine used at the point of care);
no original data (letter to the editor, comment, systematic review); not an RCT (this is only an
exclusion for KQ1, any article that may apply to KQ2 should not be excluded based on study
design);or non-English language (Appendix E, Abstract Review Form).
Abstracts were promoted to the article review level if both reviewers agreed that the abstract
could apply to one or more of the Key Questions and did not meet any of the exclusion criteria.
Differences of opinion were resolved by discussion between the two reviewers.
Article Review
Full articles selected for review during the abstract review phase underwent another
independent review by paired investigators to determine whether they should be included in the
full data abstraction. At this phase of review, investigators determined which of the Key
Question(s) and sub-question(s) each article addressed (see Appendix E, Article
Inclusion/Exclusion Form). If articles were deemed to have applicable information, they were
included in the data abstraction. Differences of opinion regarding article eligibility were resolved
through consensus adjudication.
Data Abstraction
Once an article was included at this level, reviewers were given a final option to exclude the
article if it was found to be inapplicable once the data abstraction was underway. This process
was used to eliminate articles that did not contribute to the evidence under review (see Appendix
E, General Data Abstraction Form). If an article was excluded at this level by the data abstractor,
it was moved from this level to the previous level (article review) and tagged with the
appropriate reason for exclusion.
We used a sequential review process to abstract data from the final pool of articles. In this
process, the primary reviewer completed all the relevant data abstraction forms. The second
reviewer checked the first reviewer’s data abstraction forms for completeness and accuracy.
Reviewer pairs were formed to include personnel with both clinical and methodological
19
expertise. The reviews were not blinded in terms of the articles’ authors, institutions, or journal.3
Differences of opinion that could not be resolved between the reviewers were resolved through
consensus adjudication.
For all articles, reviewers extracted information on general study characteristics: study
design, location, disease of interest, inclusion and exclusion criteria, description of the
consumers under study, and description of the CHI application (see Appendix E, General Form).
Specific participant (consumer) characteristics were abstracted: information on intervention
arms, age, race, gender, education, socioeconomic status, and other related data on the
application under study.
Outcomes data were abstracted from the articles that were applicable to Key Question 1
regarding a CHI application’s impact on a health or health care process outcome (see Appendix
E, KQ1 CHI (categorical) variables, and KQ1 CHI (continuous) variables). Articles addressing
Key Question 2 on barriers to CHI were abstracted to capture data on the condition of interest,
the CHI application, data collection/study design, and barriers identified (see Appendix E, KQ2
CHI barriers).
Quality Assessment
We assessed the included studies on the basis of the quality of their reporting of relevant
data. For the RCTs, we used the scoring system developed by Jadad et al.4 The 5 questions
(according to the Jadad criteria) used to assess the quality of RCTs were: 1) Was the study
described as randomized (this includes the use of words such as “randomly,” “random,” and
“randomization”)? 2) Was the method used to generate the sequence of randomization described,
and was it appropriate? 3) Was the study described as double-blind? 4) Was the method of
double-blinding described, and was it appropriate? 5) Was there a description of withdrawals and
dropouts?
Data Synthesis
We created a set of detailed evidence tables containing information extracted from the
eligible studies. We stratified the tables according to the applicable Key Question, and sub-
question (for Key Question 1). In addition, tables were further stratified to pool together the
common target conditions of interest. Once evidence tables were created, we rechecked selected
data elements against the original articles. If there was a discrepancy between the data abstracted
and the data appearing in the article, this discrepancy was brought to the attention of the
investigator in charge of the specific data set, and the data were corrected in the final evidence
tables. We did not quantitatively pool the data for any of the outcomes because of the marked
heterogeneity of the interventions, target conditions, and outcomes studied.
Data Entry and Quality Control

Data were abstracted by one investigator and entered into the online data abstraction forms
(see Appendix E, Forms). Second reviewers were generally more experienced members of the
research team, and one of their main priorities was to check the quality and consistency of the
first reviewers’ answers.
20
Grading of the Evidence
At the completion of our review, we graded the quantity, quality, and consistency of the best
available evidence, addressing Key Questions 1 and 2 adapting an evidence grading scheme
recommended by the GRADE Working Group5 and modified in Chapter 11 of the EPC Manual
currently under development.6 We separately considered the evidence from studies addressing
the 5 identified outcomes of Key Question 1: health care process outcomes, intermediate
outcomes, relationship-centered outcomes, clinical outcomes, and economic outcomes. Each of
these main categories was stratified into subcategories by target disease or conditions, and if a
particular outcome was evaluated by at least two RCTs, we graded the evidence. If an outcome
was evaluated by only one RCT, we did not grade the body of evidence, but rather narratively
described the information available. The body of evidence addressing Key Question 2 included a
variety of different study designs. Most of the articles under review in this category were not
RCTs and were assessed differently.
We assessed the quality and consistency of the best available evidence, including an
assessment of the risk of bias in relevant studies (using individual study quality scores), whether
the study data directly addressed the Key Questions, and the precision and strength of the
findings of individual studies. We classified evidence bodies pertaining to each Key Question
into four basic categories: (1) “high” grade (high confidence that the evidence reflected the true
effect; further research is very unlikely to change our confidence in the estimate of the effect);
(2) “moderate” grade (moderate confidence that the evidence reflected the true effect; further
research may change our confidence in the estimate of effect and may change the estimate); (3)
“low” grade (low confidence that the evidence reflected the true effect; further research is likely
to change the confidence in the estimate of effect and is likely to change the estimate); and (4)
“insufficient” (evidence was either unavailable or did not permit the estimation of an effect).
Peer Review
Throughout the project, the core team sought feedback from the internal advisors and
technical experts. A draft of the report was sent to the technical experts and peer reviewers as
well as to representatives of AHRQ. In response to the comments from the technical experts and
peer reviewers, we revised the evidence report and prepared a summary of the comments and
their disposition for submission to AHRQ.
21
Chapter 3. Results
Results of the Literature Search
The literature search process identified 24,794 citations that were deemed potentially relevant
to Key Questions 1 and/or 2 (see Figure 2) and 6673 additional articles were identified through
hand searching, as described in Chapter 2. We identified no additional eligible articles in the
grey literature. We excluded 8943 duplicate citations from the electronic search results. Most
duplicates came from concurrently searching MEDLINE®, The Cochrane Library, EMBASE®,
CINAHL, and SCOPUS. The search strategy used in all search engines was modeled on that
which we used in MEDLINE®, with similar search terms (see Appendix C1). Additionally, the
EMBASE® search engine allows the user to search the MEDLINE® database as well as
EMBASE®, a strategy that often yields many duplicates between the two search sites. Our EPC
employs this strategy to improve the sensitivity of the search.
In the title review process, we excluded 19,377 citations that clearly did not apply to the Key
Questions. In the abstract review process, we excluded 2642 citations that did not meet one or
more of the eligibility criteria (see Chapter 2 for details). At the article review phase, we
excluded an additional 340 articles that did not meet one or more of the eligibility criteria (for a
detailed list see Appendix F, list of excluded articles). Two more articles were removed from the
pool of articles identified through the electronic databases at this stage due to difficulty in
retrieving the article (Figure 2). Details on the grey literature search are available in Appendix D.
The Johns Hopkins University Welch Library works with other libraries to ensure that University
faculty and employees have access to nearly all published articles. Periodically, an article cannot
be located through any of the cooperating libraries, and the EPC team goes directly to the authors
to obtain the article — this was not possible for these two articles. Ultimately we were left with
162 articles that were eligible for inclusion in this report: One hundred thirty-seven for Key
Question 1 and 31 for Key Question 2; six articles were eligible for both Key Question 1 and
Key Question 2.
1
Appendixes and evidence tables cited in this report are available at: http://www.ahrq.gov
23
Electronic Databases
MEDLINE® (14561)
Cochrane (3716)
EMBASE® (1421)
CINAHL (1462)
SCOPUS (5577) Hand Searching
6673
Retrieved
33410
Reasons for Exclusion at Abstract Review Level*
Duplicates
No health informatics application: 843
10886
Health informatics application does not apply to the
consumer: 723
Title Review Health informatics application is for general information
22524 only :453
Study of a point of care device: 617
Excluded No original data: 673
19377 Not a RCT, and not a study addressing barriers: 168
Other: 269
Abstract Review Non-English language: 0
3147
Excluded
2642
Reasons for Exclusion at Article Review Level*

Article Review No health informatics application: 98
505 Health informatics application does not apply to the
consumer:57
Excluded
Health informatics application is for general information
341
only: 82
Study of a point of care device: 66
Included Articles unretrievable
No original data: 50
162 2
Not a RCT, and not a study addressing barriers: 38
KQ1: 137 Other: 85
KQ2: 31 Non-English language: 0
6 articles apply to KQ1
and KQ2
* Total exceeds the # in the exclusion box because reviewers were allowed to mark more than 1 reason for exclusion
Figure 2. Summary of literature search (number of articles)
24
Description of the Types of Studies Retrieved
One hundred thirty-seven studies applied to Key Question 1. The EPC team along with the
TEP and AHRQ agreed that the best evidence available to measure outcomes of the impact of
CHI applications on consumers would be found in randomized controlled trials (RCTs).
Therefore, all of the Key Question 1 eligible studies were RCTs. The above group agreed that all
study designs should be included when searching for and including articles investigating barriers
to the use of CHI applications. The 31 articles addressing barriers to use of CHI applications fell
under a variety of study designs and data collection types. Data on barriers was collected most
commonly in non-validated surveys (24) or qualitative studies (7).
Key Question 1a: What evidence exists that consumer health

informatics applications impact health care process
outcomes?
Summary of the Findings
Very few studies evaluated the impact of CHI applications on health care processes (Table
1). Measures included monitoring and therapeutic adherence, and health care utilization. The
quality of these trials was variable, ranging from moderate to very low, as measured by the
Jadad4 criteria for RCT quality (Appendix F, Evidence Table 1). Postintervention followup
duration varied from 12 weeks up to 1 year. The study results suggested a positive effect of CHI
applications on monitoring and therapeutic adherence, and health care utilization.
Strengths and Limitations of the Evidence

Five studies assessed the impact of CHI applications on health care process outcomes in
asthma, and another on the process outcome of contraceptive medication use. The asthma studies
enrolled from 527 to 2288 patients. The sample size in the contraception study was 949
(Appendix G, Evidence Tables 2-4).9 The overall strength of the body of the evidence from the
asthma studies was graded as moderate (Table 2) based on a modified version of the GRADE
criteria”5 and Chapter 11 of the EPC Manual6
General Study Characteristics

The asthma studies involved children as young as 17 years of age8,10-12 while the
contraception study participants were young women ( 20 yrs or younger). 9 One of the asthma
studies involved a majority of female participants,10 the others had a majority of male
participants.8,11,12 All of the asthma studies reported on race, one on caregiver education. The
contraception study was conducted at two separate family planning clinic sites resulting in a
highly diverse participant background in terms of race and socioeconomic status (Appendix G,
Evidence Tables 2 and 3).
25
Table 1. Summary of studies of CHI applications impacting health care process outcomes (N=5).
Target N Author, year Interventions Primary outcomes measured Effect of CHI

condition application*
Asthma 4 Bartholomew, Watch, Enhancement of self-management skills 0
12
2000 Discover,
Think and Act
(An
Interactive
multimedia
application on
CD-ROM)
Guendelman, Health Health and quality of life and process +
200211 Buddy(person evaluation
al and
interactive
communicatio
n device)
Jan, 200710 Asthma Monitoring adherence +
education and Therapeutic adherence -
an interactive Adherence to daily diary entry +
asthma Therapeutic adherence: dry powder inhaler +
monitoring (DPI) or metered dose inhaler (MDI)
system plus spacer technique score
Peak flow meter technique score -
Krishna,20038 Internet- Days of quick relief medicine +
enabled Urgent physician visit +
asthma Emergency room visit +
education
program
Oral contra- 1 Chewning, Computerized Oral contraceptive efficacy Chicago 0
ceptive use 19999 decision aid
Oral contraceptive efficacy Madison 0
* (+) positive impact of the CHI application on outcome; (-) negative impact of the CHI application on outcome; (0) no impact or
not a significant of the CHI application on outcome
DPI=dry powder inhaler; MDI=metered dose inhaler
Outcomes
Asthma. When evaluating therapeutic and monitoring adherence among children with
asthma, Jan et al10 found that the children using the Blue Angel for Asthma Kids application, an
Internet based interactive asthma program , monitored their peak expiratory flows and adhered to
an asthma diary significantly more than those receiving standard asthma education including
written diary and instructions for self management at 12 weeks ( p < 0.05) . Similarly their
therapeutic adherence to inhaled corticosteroid treatment was significantly higher (63 percent
among intervention vs. 42 percent among control group). In this intervention, participants
received a self management plan from the Blue Angel program after entering their symptoms and
peak flow measurement on a daily basis into the computer (Appendix G, Evidence Table 4).
Krishna et al8 showed a positive impact2 of an interactive computer program that delivers
tailored educational messages in the form of brief vignettes for asthma education on health care
utilization rates. This intervention was delivered in the clinic’s waiting area and required no
2
“positive impact”: the appropriate increase or decrease if a specific outcome that leads to a benefit to the consumer.
26
Table 2. Grade of the body of evidence addressing CHI impact on health care processes in
asthma.
1 Protection against risk of bias (relates to study design, study quality, reporting bias) High
2 Number of studies 4
3 Did the studies have important inconsistency? 0
y (-1); n (0)
4 Was there some (-1) or major (-2) uncertainty about the directness or extent to which the -1
people, interventions and outcomes are similar to those of interest?
Some (-1); major (-2); none (0)
5 Were the studies sparse or imprecise? 0
y (-1); n (0)
6 Did the studies show strong evidence of association between intervention and 0
outcome?
“strong*” (+1); “very strong†” (+2); No (0)
Overall grade of evidence‡ Moderate
* if significant relative risk or odds ratio > 2 based on consistent evidence from 2 or more studies with no plausible confounders
†
if significant relative risk or odds ratio > 5 based on direct evidence with no major threats to validity
‡
(high, moderate, low):if above score is (+), increase grade; if above score is (-), decrease grade from high to moderate (-1) or
low (-2).
change in clinic flow or staffing levels. In this study, all participants in the intervention and
control group also received standard education based on the National Asthma Education and
prevention program. Participants in the intervention arm had significantly fewer emergency room
visits (1.93 vs. 0.62 per year, p<0.01,) and a significantly lower daily dose of inhaled
corticosteroids (434 vs. 754 µg, p < 0.01) possibly due to improved avoidance of asthma triggers.
No statistically significant difference was found for the number of hospitalizations. Increased
knowledge levels about asthma in both the control and intervention arms positively correlated
with fewer urgent visits to physicians and reduced use of quick relief medications (correlation
coefficient r = 0.37 and 0.30, respectively)
Guendelman et al11 studied the impact of the Health Buddy (an interactive communication
device) compared to an asthma diary on health related quality of life and health processes. This
study demonstrated that the intervention group was significantly more likely to have no
limitation of activity (p=0.03), significantly less likely to report peak flow readings in the yellow
or red zone (p=.01) or to make urgent calls to the hospital (p=.05).
Finally Bartholomew et al12 evaluated an interactive multimedia computer game designed to
enhance self-management skills and thereby improve asthma outcomes. The study demonstrated
that the intervention group had fewer hospitalizations, better symptom scores, increased
functional status, greater knowledge of asthma management, and better child self-management
behavior as compared to controls at baseline. (Appendix G, Evidence Table 4).
Oral contraceptive use. In this study involving two family planning clinics, increased
knowledge about oral contraceptive methods as a result of using a decision support aid did not
reduce discontinuation rates for oral contraceptives among female adolescents (Appendix G,
Evidence Table 4). Although not a primary outcome in this study, it is interesting to note that the
reasons for discontinuation of oral contraceptives, however, were mainly medication side effects
and changes in sexual relationships altering perceived need for using contraceptives.9
27
Key Question 1b: What evidence exists that consumer health
informatics applications impact intermediate outcomes?
Breast Cancer
Three studies examined the impact of CHI in the context of breast cancer (Table 3), 13-15 and
one of these was a study of multiple cancers that included breast cancer.15 Outcomes examined
were similar in two of the studies, which were from the same research group and involved the
same CHI intervention (Comprehensive Health Enhancement Support System [CHESS]). These
studies examined quality of life, as well as the woman’s perception of social support, unmet
information needs, information competence, and involvement in her own health care.13,14 One
additional study addressed satisfaction with the information, computer versus provider
consultation preference, and anxiety and depression.15
Over the longer term, CHESS participants reported better social support and information
competence than the comparison groups.13,14 In the study comparing personalized computer
information with two comparison groups -- general computer information and information
booklets – patients given access to personalized information on the computer a few days after
they were given information about their cancer were more satisfied than patients in the other two
groups.

Only three studies examined intermediate outcomes in patients with breast cancer, and one
included a spectrum of different types of cancer, with breast cancer patients representing about
half of all patients. The test interventions and outcomes examined were identical or nearly so in
two of the trials, with outcome measures designed to be short term. Sample sizes in each of
these studies were modest. All three studies were randomized, with only one 15 providing the
details of how the randomization sequence was generated (a random numbers table), and only
one 14 providing details on how allocation was concealed (sealed envelopes). Intermediate
outcomes were all self-reported, and masking of the patients was not possible. Dropouts and
withdrawals over the study period were over 10 percent in the 2001 CHESS study, 13 and slightly
less in the 1999 CHESS study, 14 and nearly 20 percent in the study by Jones and colleagues. 15
An intention-to-treat analysis was only performed in the 2008 CHESS study.14 Overall, these
studies were given a low study quality score according to the Jadad criteria4 (See Appendix G,
Evidence Table 1). The overall strength of this body of evidence was graded as low (Table 4)
based on a modified version of the GRADE criteria”5 and Chapter 11 of the EPC Manual6
28
Table 3. Results of studies of CHI applications impacting intermediate outcomes in breast cancer
(N=3).
Target Effect of CHI

condition N Author, year Interventions Primary outcomes measured application*
Breast 3 Jones, Computer- Satisfaction Score >2, n(%) a few days +
15
cancer 1999 Personal after information given
Information via Prefer computer to 10 minute ‐
computer consultation with professional (at 3
†
months of follow up)
Computer -
General
information
about cancer
Gustafson, CHESS Social Support +
200113 Information competence 0
Unmet information needs 0
Participation, behavioral involvement +
Participation, level of comfort +
Confidence in doctors 0
Gustafson, CHESS Social support +
14
2008
†
A 10 minute professional consultation was preferred to the intervention, however, the group randomized to the internet group
was more likely to prefer using it.
CHESS = Comprehensive Health Enhancement Support System
Table 4. Grade of the body of evidence addressing CHI impact on intermediate outcomes in breast
cancer.
1 Protection against risk of bias (relates to study design, study quality, reporting bias) Moderate
y (-1); n (0)
4 Was there some (-1) or major (-2) uncertainty about the directness or extent to which the 0
5 Were the studies sparse or imprecise? -1
y (-1); n (0)
outcome?
Overall grade of evidence‡ Low
†
‡
low (-2).
29
The studies identified were evaluations of the impact of CHI applications on intermediate
outcomes tested among adult populations with cancer. One study included patients younger than
6113 (mean age about 44 years old), and the other two studies did not report patient ages. One
study16 reported on the percent of “Caucasian” study participants – about 75 percent
Outcomes
In the 2001 CHESS study,13 patients allocated to CHESS reported statistically significantly
greater social and information support, participation in health care, and confidence in the doctor, but
not greater quality of life than patients with Internet access alone, at 2 months of followup. The
positive effect of CHESS remained for social support at 5 months while no evidence of a beneficial
effect of CHESS was observed at 5 months for information support, participation in health care,
confidence in the doctor, or quality of life (Appendix G, evidence Table 7).
In the 2008 CHESS study,14 patients allocated to CHESS reported greater social support during
the 5-month intervention period than did those offered books and audiotapes or those in the Internet
access group. At 9 months, about 4 months after the intervention period ended, the CHESS group
reported greater quality of life, social support, and health and information competence compared with
the control group offered books and audiotapes, but not compared with the group given Internet
access (Appendix G, evidence Table 7).
Jones et al15found that at the time the intervention was offered, more patients in the Internet
groups (both personal and general information), found information more easily than those offered
booklets, and those given booklets felt more overwhelmed by the information. However, respondents
allocated to the computer groups more often found the information available too limited, compared
to those assigned to the booklets. At 3 months of followup, all three groups overwhelmingly
preferred a 10 minute professional consultation to use of the computer, although those assigned to the
computer were more likely to prefer the computer (29 percent of those receiving personal
information on the computer vs. 20 percent general information vs. 10 percent booklet information).
At 3 months of followup, significantly more patients assigned to the general computer information
group reported anxiety and depression (Appendix G, Evidence Table 7).
Diet, Exercise, Physical Activity, not Obesity

Thirty-two studies evaluated the impact of CHI applications on a variety of intermediate
health outcomes related to diet, exercise, or physical activity, not obesity, including self-
management, knowledge attainment (program adherence), and change in health behaviors (Table
5). The quality of these trials was highly variable with Jadad4 study quality scores ranging from
very low to moderately high (although only one of the 32 articles was scored as moderately high)
(Appendix G, Evidence Table 1). Included in the 32 studies were two studies that evaluated the
impact of CHI applications on outcomes related to eating disorders, one of which focused
specifically on overweight and binge eating,
30
Table 5. Results of studies on CHI applications impacting intermediate outcomes in diet, exercise,
or physical activity, not obesity (N=32).

condition N Author, year Interventions Primary outcomes measured Application*
Diet, exercise, 32 Adachi, Computer Body Weight +
‡17
physical 2007 tailored BMI +
activity, not program with Percent weight loss +
obesity 6-month
weight and
targeted
behavior’s self-
monitoring,
Computer
tailored
program only
Anderson, Computer Fat (% calories) Composites Scores 0
18
2001 kiosk nutrition Fiber (g/1,000kcals) 0
intervention Fruit and vegetables 0
(servings/1000kcals)
Self Efficacy/ Low-Fat Meals 0
Self-Efficacy/ Low-Fat Snacks 0
Self-Efficacy/Fruit, Vegetables, Fiber 0
Outcome Expectations/Appetite 0
Satisfaction
Outcome Expectations/Budgetary 0
Outcomes
Outcome Expectations/Health 0
Outcomes
Brug, 199619 Tailored Fat (points per day) +
feedback Vegetables (servings per day) 0
Fruit (servings per day) 0
Positive attitude to increasing +

vegetables and fruits
Brug, 199820 Computer- Fat (fat points per day) +
tailored fat, Fruit (servings per day) +
fruit, and Vegetables (servings per day) 0
vegetable
intake
intervention
Brug, 199921 Computerized Fat score 0
feedback on Servings of vegetables +
fat, fruit, and Servings of fruit 0
vegetable Intention to reduce fat intake 0
intake Intention to increase vegetable intake 0
Campbell, Tailored Fat (g/day) +
22
1994 nutrition
intervention
Campbell, Tailored Knowledge score of low fat foods 0
23
1999 multimedia Self-efficacy 0
intervention Fat score 0
Stage of change- Precontemplation +
Stage of change- Contemplation 0
Stage of change- Preparation 0
Stage of change- Action/maintenance 0
31
or physical activity, not obesity (N=32) (continued).

Diet, exercise, Campbell, Computer Total Low-fat +
24
physical 2004 based knowledge score
activity, not interactive
obesity nutrition Total Infant feeding +
(continued) education knowledge score
Total self-efficacy score 0
Haerens, CD-ROM Fat intake (g/day, day 21) 0

200525 based nutrition Fruit intake (pieces week) 0
support Soft drinks (glasses day) 0
Water (glasses/day, day 21) 0
Pre- and post-test intake levels for fat +
intake in girls
Pre- and post-test intake levels (mean ^ +
SD) for % energy from fat in girls
Haerens, Computer Dietary fat intake 0
200726 tailored
intervention
Haerens, Computer- Cycling for transportation 0
200927 tailored Walking for transportation 0
exercise Walking in leisure time 0
intervention Total moderate to vigorous activity 0
Hurling, Internet-based Change in perception of exercise +
200628 exercise Change in ratings of expectation; +
motivation satisfaction with motivation to exercise
The mean change in ratings of the 0
statement ‘‘I am very satisfied with my
current level of motivation to do
exercise’
Hurling, Had access to MET min/week 0
29
2007 Internet and Change in weekly hours spent sitting +
mobile phone (MET min/week leisure time)
Jones, Student Bodies BMI +
30§
2008 2 -BED BMIzScore +
Binge eating (OBEs and SBEs) +
Binge eating (OOEs) 0
Weight and shape concerns +
Dietary fat intake 0
Depressed mood 0
31
King, 2006 Interactive CD- Total physical activity +
ROM for health Moderate physical activity +
risk appraisal
32

Diet, exercise, Kristal 200032 Computer- Fat-related diet habit +
physical generated Fruit and vegetables (servings/day) +
activity, not personalized
obesity letter for fruit
(continued) and vegetable
intake
Lewis, 200833 Internet-based median number of logins +
physical
activity 5-itemWebsite Quality +
program Questionnaire
Low, 200634 Student bodies EDI- Bulimia +
with a
moderated EDI-Body Dissatisfaction +
discussion Weight and Shape Concerns +
group
Un-moderated
discussion
group
Program alone
Marcus, Tailored Physical activity per week 0
200735 Internet Improvement in functional capacity 0
(estimated volume 02 at 85% of
Standard predicted maximum heart rate)(ml/kg
Internet per minute)
150 minutes of physical activity per 0
week
Mangun- Internet Group Evaluation of Health 0
kusumo, Evaluation of Fruit Advice (pleasant) +
200736 (Likert Scale)
Acceptability (Was fruit advice targeted +
to you?)
Acceptability (Did you enjoy it?) +
Quality of Intervention (relevant) 0
Quality of Intervention (credible) +
Quality of Intervention (useful) +
Napolitano, Internet Minutes moderate physical activity +
200337 intervention Minutes, walking +
Stage of change, progression +
Oenema, Web based Intention to eat less fat +
38
2001 tailored Self-rated fat intake compared to others +
nutrition Self-rated fruit intake +
education Self rated fat intake +
Self rated fruit intake compared to +
others
Self-rated vegetable intake 0
Self-rated vegetable intake compared to 0
others
33

Diet, exercise, Richardson, Group Total Steps 0
39
physical 2007 receiving Bout Steps 0
activity, not tailored
obesity feedback on
(continued) lifestyle goals
Silk, 200840 Web site Likeability of learning materials +
(hypothesis 1) [authors identify 3
Video game subscales -- attention,
understanding, intention]
Nutrition literacy scores (hypothesis 2) +
[authors identify 6 subscales:
MyPyramid, Food groups, Food
servings, Serving size, Food safety,
Food cost]
Smeets, Intervention Fat consumption (gm) +
200741 group, Fruit consumption (pieces/day) +
receiving one
tailored letter
Spittaels, On-line tailored Increase in total physical activity +
42
2007 Physical Increase in moderate to vigorous +
activity physical activity
advice+ stage Increase in physical activity in leisure +
based time
reinforcement
emails
On-line tailored
physical
activity advice
Spittaels, Website with Total moderate to vigorous physical 0
200743 computer activity scores
tailored
feedback on
physical
activity
†44
Tate, 2006 Tailored Dietary intake (kcal/day) +
Computer- Fat intake (% day) +
Automated Physical activity (kcal/week) +
Feedback
Human Email
Counseling
34
or physical activity, not obesity (N=32).(continued).

Diet, exercise, Vandelanotte, Sequential Increase physical activity +
45
physical 2005 interactive Decrease fat intake +
activity, not computer
obesity tailored
(continued) intervention
Simultaneous
interactive
computer
tailored
intervention
Verheijden, Web-Based Perceived support 0
200446 Targeted Social network 0
nutrition BMI ( kg/m2) 0
counseling and Systolic blood pressure 0
social support Diastolic blood pressure 0
Total cholesterol 0
Winzelberg, Internet- Body Shape Measure +
200047** delivered EDI-drive for thinness +
computer- EDI-Bulimia 0
assisted health EDE-Q Weight Concerns 0
education EDE-Q Shape Concern 0
program Saturated Fat (g/day) +
Vegetable/Fruit (servings/day) +
Wylie-Rosett, Computer Dietary Intake 0
200148 tailored Exercise (Blocks walked daily) 0
lifestyle Exercise (min walked continuously) 0
modification Weight (lb) +
BMI +
†
There were significant effects of human email counseling and computer-automated counseling on decrease in fat intake when
compared to control; however, no treatment difference between the human email counseling and computer-automated counseling
were demonstrated.
‡
Long-term effects of a 1-month behavioral weight control program assisted by computer tailored advice with weight and
targeted behavior self-monitoring were more effective when compared to the behavioral weight control program assisted by
computer tailored advice alone, an untailored self-help booklet with self-monitoring of weight and walking, and a self-help
booklet alone.
§
study focuses on binge eating and overweight
║
z score: “A z-score is the deviation of the value for an individual from the mean value of the reference population divided by the
standard deviation for the reference population. Because z-scores have a direct relationship with percentiles, a conversion can
occur in either direction using a standard normal distribution table. Therefore, for every z-score there is a corresponding
percentile and vice versa.”49
**Study focused on eating disorders.
BMI=body mass index; EDE-Q = Eating Disorder Examination—Questionnaire; EDI = Eating Disorder Inventory; g/day =
grams per day; gm = gram; g/1,000 = grams per 1,000; kcal = kilocalorie; kg/m2 = kilogram per meter squared; lb = pound;
ml/kg = milliliters per kilogram ; min/wk = minutes per week; OBE= objective binge episode; OOE= objective overeating
episode; SBE= subjective binge episode; SD = standard deviation
35
Twenty-nine studies are available to evaluate CHI impact on intermediate health outcomes
within the context of diet, exercise, or physical activity, not obesity. Additionally two studies
were available to evaluate impact within the contexts of eating disorders and one study was
available to evaluate the impact in the context of overweight and binge eating. Limitations
included the occasional imprecision of study results due to wide-ranging confidence intervals.
Many, though not all of these studies relied on very small sample sizes. (Appendix G, Evidence
Tables 8-10). The overall strength of the body of this evidence (Table 6) on the impact of CHI
applications on diet, exercise, or physical activity, not obesity was graded as moderate based on
a modified version of the GRADE criteria5 and Chapter 11 of the EPC Manual6 All of the
studies were included in this grading of the evidence because they all had at least one outcome
relevant to the effects on diet, exercise, or physical activity, not obesity.
Table 6. Grade of the body of evidence addressing CHI impacts on intermediate outcomes in diet,
exercise, nutrition intervention (not obesity).
y (-1); n (0)
y (-1); n (0)
outcome?
†
‡
low (-2).

The studies on the impact of CHI applications on intermediate health outcomes were
generally conducted among adult, non-elderly populations. Five studies however were
conducted specifically among adolescent populations 25,26,27, 25,27,30,36 (Appendix G, Evidence
Tables 8 and 9).
Many studies were conducted among female participants. When reported, the race/ethnicity
of respondents was generally such that the majority of subjects identified as Caucasian, with
smaller percentages of Asian, Native American, African American or Black, or other groups
reported. Educational level varied, with higher rates of higher education within studies conducted
among young adults in the workplace or on college campuses. Patient post-intervention
evaluation ranged from as little as immediately post-test to as long as twelve months. Upon
36
review, the body of scientific evidence from these studies indicated that most CHI applications
evaluated to date had effects on intermediate health outcomes (Appendix G, Evidence Tables 8
and 9).
Outcomes
Diet, exercise, or physical activity, not obesity. Haerens et al25 evaluated the effects of a
middle-school healthy eating promotion intervention combining environmental changes and
computer-tailored feedback, with and without an explicit parent involvement component. This
study demonstrated that in girls, fat intake and percentage of energy from fat decreased
significantly more in the intervention group with parental support, compared with the
intervention alone group (p = 0.05) and the control group (p=0.001). No impacts were found in
boys or in girls for fruit, soft drinks, and water consumption.
In another study by Haerens et al27 evaluated the differences in effects of a computer tailored
physical activity advice as compared to providing generic information among adolescents. After
4 weeks, most physical activity scores increased in both groups. No differences between groups
were found. After 3 months, the generic intervention was more effective at increasing “walking
in leisure time” among students not complying with recommendations. For all other physical
activity scores, no differences between groups were found.
In a third study Haerens et al 26 investigated a computer-tailored dietary fat intake
intervention for adolescents as compared to control and found no intervention effects for the total
sample.
Marcus et al 35 investigated the effects of an internet-based tailored physical activity
intervention, a standard internet physical activity intervention, and a tailored print physical
activity intervention and found that all groups increased physical activity behavior similarly and
no significant treatment effects were detected between groups.
When evaluating behavior change regarding changes in weekly hours spent sitting, Hurling
et al29 found that an Internet and mobile phone technology delivering an automated physical
activity program was associated with greater perceived control and intention/expectation to
exercise when compared to a control group than those who received no support (p<0.001)
(Appendix G, Evidence Table 10).
Regarding a decrease in fat consumption and increase in fruit consumption, Smeets et al41
found that a computer tailored intervention was associated with these behaviors at 3 months
(p<0.05 and p<0.01, respectively). While this intervention did not enhance the health behaviors,
it did reduce the decline in these behaviors over the followup period (Appendix G, Evidence
Table 10).
Spittaels et al42 found that an increase in total physical activity, increase in moderate to
vigorous physical activity, increase in physical activity during leisure time, and decrease in body
fat were behaviors more strongly associated with use of an online-tailored physical activity
advice program with stage-based reinforcement emails when compared to online-tailored
physical activity advice without reinforcement emails or on-line non-tailored standard physical
activity advice (p<0.001, p<0.05, p<0.001, and p<0.05, respectively) (Appendix G, Evidence
Table 10).
Tate et al 44 investigated the effects of human e-mail counseling, computer-automated
tailored counseling, and no counseling in an internet weight loss program. Significant effects of
human email counseling and computer-automated counseling on decrease in fat intake when
37
compared to control were demonstrated at 3 and 6 months (p<0.04 and p<0.004, respectively);
however, no treatment difference between the human email counseling and computer-automated
counseling were demonstrated. (Appendix G, Evidence Table 10)
Mangunkusumo et al36 found that Internet-administered adolescent health promotion in a
preventive-care setting was more effective when compared to a control of usual practice with
paper and pencil for some outcomes but not for others. Subjects found the Internet-tailored fruit
advice more pleasant, easy to use, personally targeted, and enjoyable but less credible when
compared to generic preprinted advice (p<0.01) (Appendix G, Evidence Table 10).
Adachi et al17 found that the long-term effects of a 1-month behavioral weight control
program assisted by computer tailored advice with weight and targeted behavior self-monitoring
was more effective when compared to the behavioral weight control program assisted by
computer tailored advice alone, an untailored self-help booklet with self-monitoring of weight
and walking, and a self-help booklet alone. While dietary habits and physical activity were
improved in all subjects, the mean weight loss associated with these improvements was greatest
in the behavioral weight control program assisted by computer tailored advice with weight and
targeted behavior self-monitoring (p<0.05) (Appendix G, Evidence Table 10).
Vandelanotte et al45 found that sequential and simultaneous interactive computer-tailored
interventions were more effective when compared to a control group for producing higher
physical activity scores and lower fat intake scores (p<0.001) (Appendix G, Evidence Table 10).
Verheijden et al 46 investigated Web-based targeted nutrition counseling and social support
for patients at increased cardiovascular risk in general practice as compared to control treatment
of usual care and found no significant treatment differences in outcomes (Appendix G, Evidence
Table 10).
In another study, Oenema et al38 found that a Web-based tailored nutrition education
intervention had greater effect on self-rated fruit intake compared to others as well as intention to
eat less fat when compared to a control group at post-test (p<0.01, p<0.05, and p<0.01,
respectively) (Appendix G, Evidence Table 10).
Napolitano et al37 found that an Internet-based physical activity intervention was more
strongly associated with progression in stage of motivational readiness for physical activity when
compared with a control group at one month (p<0.05) and at three months (p<0.01).
Additionally, the Internet-based physical activity intervention was also more strongly associated
with increases in walking minutes when compared with a control group at one month (p<0.001)
and at three months (p<0.05) (Appendix G, Evidence Table 10).
Caroline et al39 evaluated the effect of technology enhanced pedometers and interactive,
tailored, Web based, feedback on physical activity among sedentary adults with Type II
Diabetes. Individuals in all groups increased their physical activity from baseline, however no
significant between group differences were achieved.
In a study conducted with patients attending family practice clinics in North Carolina
Campbell et al22 tested the effect of individually computer-tailored messages designed to
decrease fat intake and increase fruit and vegetable intake. At 4 month followup, the data
indicated that the tailored intervention produced significant decreases in total fat and saturated
fat scores compared with those of the control group p<0.05). Fruit and vegetable consumption
did not increase in any study group.
Kristal et al32 evaluated a tailored, multiple-component self-help intervention designed to
promote lower fat and higher fruit and vegetable consumption .The intervention consisted of a
computer-generated personalized letter and behavioral feedback, a motivational phone call, a
38
self-help manual and newsletters and was compared to a no material control. The intervention
significantly reduced fat intake (p<0.001) and significantly increased fruit and vegetable intake
(p<0.001) as compared to controls.
Hurling et al28 evaluated an Internet-based exercise motivation and action support system
(Test system), relative to a group receiving no intervention (Reference) and another receiving a
less interactive version of the same system (Control). Seven months after the intervention,
participants who used the test system reported greater levels of increase in exercise motivation
than the control or reference groups (p < 0.05).
Brug et al21 evaluated the impact of two computer-tailored nutrition education interventions
and tailored psychosocial feedback compared to computer tailored nutrition education alone,
regarding reducing their fat consumption and increasing consumption of fruit and vegetables.
No significant differences in consumption of fat, fruit, and vegetables were found.
In another study by Brug et al20 the impact of individualized computer-generated nutrition
information and additional effects of iterative feedback on changes in intake of fat, fruits, and
vegetables was evaluated. The experimental group received computer-generated, tailored dietary
feedback letters. Half of the experimental group received additional iterative tailored feedback.
Controls received a single general nutrition information letter. The results indicated that
Computer-tailored feedback had a significantly greater impact on fat reduction (p<0.01) and
increased fruit (p<0.01) and vegetable intake (p<0.01) than did general information. Iterative
computer-tailored feedback had an additional impact on fat intake (p=0.02).
Anderson et al 18 studied the impact of a self administered computer tailored nutrition
intervention. The application was located in kiosks and involved local grocery store shoppers.
The results indicate that while an immediate post test suggested that individuals in the
intervention group were more likely to attain dietary fat (p<0.001), fiber (p<0.001), fruits and
vegetable consumption goals (p<0.05), they were only more likely to achieve dietary fat
(p<0.05) and fiber (p<0.01) goals at follow up.
Campbell et al23 evaluated a tailored multimedia program designed to improve dietary
behavior among low income women. The computer-based intervention consisted of a tailored
soap opera and interactive ‘infomercials’ that provided individualized feedback about dietary fat
intake, knowledge and strategies for lowering fat based on stage of change. Results from this
study indicate that the intervention group participants had improved significantly in knowledge
(P < 0.001), stage of change (P < 0.05) and certain eating behaviors (P < 0.05) compared to the
control group.
In another study Campbell et al24 evaluated a tailored nutrition education CDROM program
for participants in the Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC). Results from this study indicate that intervention group members increased self-efficacy
(p<0.01) and scored significantly higher (p<0.05) on both low-fat and infant feeding knowledge
compared with controls. No differential effect was observed for dietary intake variables.
Lewis et al33 evaluated the impact of instantaneous Web-based tailored feedback vs. general
Websites currently available to the public among sedentary adults. The results indicated that
individuals in the intervention group logged onto their Website significantly more times than the
general Website controls (median 50 vs. 38; pb.05). Among participants in the intervention, the
self-monitoring feature (i.e., logging) followed by goal setting were rated as the most useful
Website components.
King et al31 evaluated the impact of a computer-assisted, tailored self-management physical
activity intervention compared with health risk appraisal with feedback on sedentary adults with
39
Type II Diabetes. At 2-month post intervention follow-up, the intervention significantly
improved all physical activity (p<0.01) and moderate physical activity (metabolic equivalents >
3.0, p<0.01) relative to controls.
Spittaels et al43 evaluated a Website-delivered physical activity intervention, that provides
participants with computer-tailored feedback, to ascertain the impact of the intervention on
physical activity in the general population. Potential participants were allocated to one of three
study groups. Participants in group 1 and 2 received the tailored physical activity advice on their
computer screen immediately following their baseline assessment with the option to visit other
Website sections. Participants in group 1 also received non-tailored e-mails inviting them to visit
a specific Website section by following a hyperlink. Group 3 was a delayed treatment control
group. Participants in both intervention groups reported a significant increase in transportation
(movement, walking or running) (p<0.05), leisure time physical activity levels (p<0.05), and
decrease in time spent sitting (p<0.05) at 6-month follow-up compared with the control group.
Wilie-Rosett et al48 evaluated the impact on weight loss of kiosk-based computer-tailored
behavioral feedback versus the computer feedback plus in-person consultation versus a print
workbook control. The results indicate that all groups had a significant decrease in energy and fat
intake and increased physical activity (p<0.01). The greater the intensity of the intervention, the
greater the increase or decrease.
When evaluating likeability of learning materials and nutrition literacy attainment, Silk et al40
found that an interactive Web site modality was associated with higher scores among participants
when compared with a computer game and an information pamphlet at 2 weeks (p<0.05)
When evaluating reduction of fat intake and positive attitudes regarding this behavior, Brug
et al19 found that a computer-tailored nutrition intervention with tailored feedback letters was
more strongly associated with these outcomes when compared to a control group receiving
general nutrition information at three weeks (p<0.01) (Appendix G, Evidence Table 10).
Eating Disorder. When evaluating drive for thinness and body shape concerns, Winzelberg
et al47 found that the Internet-delivered computer–assisted health education program Student
Bodies was associated with a decrease in these behaviors when compared to a control group at
three months (p<0.05 and p<0.01, respectively) (Appendix G, Evidence Table 10).
Low et al34 found that decreases in self-reported bulimia, body dissatisfaction concerns, and
weight and shape concerns were more strongly associated with the use of a computer-based
interactive eating disorder prevention program (Student Bodies) with an unmoderated discussion
group when compared to the Student Bodies program with a moderated discussion group, the
Student Bodies program alone, or a control group (p<0.05) (Appendix G, Evidence Table 10).
Overweight and binge eating. When evaluating binge eating behaviors and concern with
weight and shape, Jones et al30 found that the Internet-facilitated intervention Student Bodies2-
Binge Eating Disorder (SB2-BED) was associated with a decrease in these behaviors when
compared to a wait-list control at 16 weeks (p<0.05) (Appendix G, Evidence Table 10).
40
Alcohol Abuse and Smoking Cessation
Twenty-six studies evaluated the impact of CHI applications on a variety of intermediate
health outcomes related to the use of alcohol and tobacco (Table 7). Outcomes of interest include
self-management, knowledge attainment (program adherence), and change in health behaviors.
The quality of these 26 trials was good. All were RCTs with sample sizes ranging from 83 to 288
respondents for the alcohol abuse studies and ranging from 139 to 3971 respondents for the
tobacco use studies. Post-intervention evaluation ranged from as little as 30 days to as long as 24
months. Upon review, the body of scientific evidence from these studies indicates that most CHI
applications evaluated to date had statistically significant effects on intermediate health
outcomes.

Twenty-six studies were available to evaluate CHI impact on intermediate health outcomes
related to use of alcohol and tobacco. Seven studies were available to evaluate CHI impact
within the context of alcohol abuse and 19 studies were available to evaluate this impact within
the context of tobacco use. The sample sizes yielded appropriate power in these studies, with
sample sizes ranging from 83 to 288 respondents for the alcohol abuse studies and ranging from
139 to 3971 respondents for the tobacco use studies. The overall strength of the body of this
evidence (Table 8) for the effects on intermediate outcomes was graded as high for smoking
cessation and high for alcohol abuse based on a modified version of the GRADE criteria5 and
Chapter 11 of the EPC Manual6. It is important to note that many of the intermediate outcome
measures were patient-reported.

The studies on the impact of CHI applications on intermediate health outcomes related to use
of alcohol and tobacco were generally conducted among adult, non-elderly populations. Most of
the respondents in these studies were under 40 years of age, although the mean age range of
participants across studies was 18-70 years of age. Five studies 50-54 specifically targeted either
adolescents or young adults (age range 11-26 years). Information regarding gender suggested
that female participants represented a little over half of the study population. When reported, the
race/ethnicity of respondents was generally Caucasian, with smaller percentages of Asian, Native
American, African-American or Black, or other groups participating. Educational level and
marital status was variable across studies. (Appendix G, Evidence Tables 11, 12, 14, 15).
41
Table 7. Results of studies on CHI applications impacting intermediate outcomes in alcohol abuse
and smoking (N=26).

Alcohol abuse 7 Cunningham, Internet plus Mean drinks per typical week +
‡55
2005 self help book Mean AUDIT test score +
Mean # of alcohol consequences +
Hester, DCU/Immediate Average drinks per day +
200556 treatment group Drinks per drinking day 0
Average peak BAC +
Kypri, 199951 Computerized Drinking Frequency +
Assessment
and Behavioral
Intervention
Lieberman, Multimedia Number of modules complete +
57
2006 Perceived helpfulness of the modules 0
Neighbors, Computerized Effect size in perceived norms 0
200452 normative Effect size in reduction in alcohol +
feedback consumption
Effect size in reduction in alcohol +
consumption
Riper, 200858 Intervention Weekly alcohol consumption (second +
condition DL outcomes)
59
Riper, 2008 Web-based self- Mean alcohol consumption at 6 months +
help and 12 months follwup
intervention
without therapist
guidance
Smoking 19 An, 200853 Real U‡ Percent abstinent for 30 days +
intervention
Brendryen, Happy ending Repeated Points of Abstinence (1 + 3 + +
2008 60 program— 6 + 12 months)
internet
delivered
smoking
cessation
Curry, 1995 61 Computer- 7-day abstinence at 21 months 0
generated Abstinent at 3, 12 and 21 months 0
tailored
feedback
Dijkstra, 2005 Computer Affective attitude +
62
tailored letters Cognitive attitude +
Quitting attempts +
Hang, 2009 63 Personalize Number of cigarettes smoked per day
smoking 24 hour quit attempt 0
cessation via 0
SMS
Japuntich, CHESS SCRP Abstinent 0
200664
Pattens, Internet based Smoking abstinence 0
54
2006 intervention
Prochaska, Interactive Point Prevalence Abstinence, 0
65
1993 computer Precontemplation stage
support Point Prevalence Abstinence, 0
Contemplation stage
Point Prevalence Abstinence, 0
Preparation stage
42
and smoking (N=26) (continued).

Smoking Prokhorov, CD-ROM Smoking initiation rates at 18 months 0
66
(continued) 2008 smoking (nonsmokers at baseline)
cessation Smoking cessation rates at 18 months 0
(smokers at BL)
Severson, Interactive, Tobacco abstinence (complete case) +
67 tailored Web-
2008 Tobacco abstinence (intent-to-treat) +
based Smokeless tobacco use abstinence +
intervention (complete case)
Smokeless tobacco use abstinence +
(intent-to-treat)
Schiffman, Computer Abstinence rates +
200068 tailored smoking
cessation
materials
Schumann, Computer Average probability of progression 0
69
2006 generated (precontemplation and contemplation)
tailored letters Average probability of regression 0
(precontemplation and contemplation)
Schumann, Computer- Point-prevalence abstinence 0
70 tailored smoking
2008 Prolonged abstinence 0
cessation
intervention
Strecher, High depth Depth of efficacy expectation of 0
71
2008 efficacy smoking cessation intervention
expectation Depth of outcome expectation of 0
smoking cessation intervention
Low depth Depth of success stories of smoking +
efficacy cessation intervention
expectation Personalization of message source +
Timing of message exposure 0
Strecher, Web-based Tobacco related illness +
200672 Committed Non-smoking children in household +
Quitters Stop Frequency of alcohol consumption +
Smoking Plan
(CQ Plan)
Strecher, Computer- 7-day abstinence at 12 months (intent +
73
2005 generated to treat analysis)
tailored letter 7-day abstinence at 12 months of 0
subjects who were abstinent at 5
months (intent to treat analysis)
7-day abstinence at 12 months of +
subjects who were abstinent at 5
months (per protocol analysis)
Strecher, CQ Plan 28 day abstinence rate +
74
2005 10 week continuous rates +
Strecher, Computer- 7-day abstinence (all smokers) 0
75
1994 generated 7-day abstinence (light smokers) +
Study 1 tailored letter 7-day abstinence (heavy smokers) +
43
and smoking (N=26) (continued).

Swartz, Received Cessation of smoking at 90 days +
76
2006 immediate
access to the
Web site
Behavioral
intervention for
smoking (intent
to treat model)
†
significance of these outcomes was not reported
‡
Study investigates internet-based intervention with addition of self-help booklet compared to internet-based intervention alone
‡
a randomized trial testing a Web‐assisted cessation intervention for college smokers
AUDIT = Alcohol Use Disorders Identification Test; BAC = blood alcohol concentration; BL = baseline;
CHESS SCRP= Comprehensive Health Enhancement Support System for Smoking Cessation and Relapse Prevention;
CQ Plan = committed quitters plan; DCU = Drinker’s Check-up; DL = drinking less
Table 8. Grade of the body of evidence addressing CHI impact on intermediate outcomes in
alcohol abuse and smoking.
1 Protection against risk of bias (relates to study design, study quality, reporting (Alcohol (Smoking
bias) abuse) cessation)
High High
2 Number of studies 7 19
3 Did the studies have important inconsistency? 0 0
y (-1); n (0)
4 Was there some (-1) or major (-2) uncertainty about the directness or extent to 0 0
which the people, interventions and outcomes are similar to those of interest?
5 Were the studies sparse or imprecise? 0 0
y (-1); n (0)
6 Did the studies show strong evidence of association between intervention and 0 0
outcome?
Overall grade of evidence‡ High High
†
‡
low (-2).
Outcomes
Alcohol abuse. Riper et al58 investigated the effects of a Web-based, multi-component,

interactive self-help intervention for problem drinkers without therapist guidance compared to a
control intervention consisting of receiving access to an online psychoeducational brochure on
44
alcohol use. Based on complete case analysis, the intervention group decreased their mean
weekly alcohol consumption significantly more than the control group (p=0.001). In a
subsequent secondary analysis of data from this study the authors demonstrated that at six and 12
month follow up women and those with higher levels of education were more likely to have
lower alcohol consumption levels, based on self report, as compared to controls.59 (Appendix G,
Evidence Table 13).
Lieberman57 investigated program adherence to an online alcohol-use evaluation among
study participants. After completing four standard questionnaires to evaluate problem drinking,
an intervention consisting of a multimedia condition involving a personified guide was compared
with a control treatment of feedback from the questionnaire results in text form. Increased levels
of program adherence, as assessed by completion of greater numbers of modules of the online
alcohol-use evaluation, were more strongly associated with the multimedia feedback via the
personified guide (p<0.01) (Appendix G, Evidence Table 13).
Cunningham et al55 investigated the effects of an Internet-based personalized feedback
intervention compared to the same intervention with the addition of a self-help book based on
three outcomes: mean typical number of drinks per week, mean Alcohol Use Disorders
Identification Test (AUDIT) scores, and mean number of alcohol consequences experienced.
Study participants who received the additional self-help book reported decreased consumption of
alcoholic drinks per week (p<0.05), a lower AUDIT score (p<0.05), and fewer alcohol-related
consequences (p<0.05) compared to participants who received the Internet-based intervention
alone (Appendix G, Evidence Table 13).
Hester et al56 investigated the effect a computer-based brief motivational intervention, the
Drinker’s Checkup (DCU). The intervention was randomly assigned to participants in either an
immediate treatment group or to a 4-week Delayed Treatment group and participants were
followed over a 12-month period. Significant effects were reported for the Immediate group
when comparing baseline measurement to measurement at 12 months for the outcomes of
average drinks per day and average peak blood alcohol content (BAC) (p=0.002 and p=0.001,
respectively). For the Delayed group, significant effects were also reported when comparing
baseline measurement to measurement at 12 months for the outcomes of average drinks per day
and average peak BAC (p=0.008 and p=0.003, respectively). Significance was not reported for
the outcome of drinks per drinking day for either the Immediate or Delayed Treatment groups
Kypri et al51 investigated the effects 10-15 minutes of Web-based assessment and
personalized feedback for hazardous drinking as compared with a control treatment of an
informational leaflet only. Six outcomes were measured at 6 weeks and 6 months: frequency of
drinking; typical occasion quantity; total consumption; frequency of very episodic heavy
drinking; personal, social, sexual, and legal consequences of episodic heavy drinking; and
consequences related to academic performance. Significant effects of the intervention were seen
on outcomes of total consumption at 6 weeks (p=0.03); frequency of very episodic heavy
drinking at 6 weeks (p=0.02); and personal, social, sexual, and legal consequences of episodic
heavy drinking at both 6 weeks and 6 months (p=0.01 and p=0.03, respectively). No significant
effects of the intervention on other outcomes were demonstrated (Appendix G, Evidence Table
13).
Neighbors et al 52 investigated the effects of a computer-delivered personalized normative
feedback intervention in decreasing alcohol consumption among heavy-drinking college
students. Outcomes assessed were effect size in perceived norms and the effect size in reduction
45
in alcohol consumption. The effect size for the intervention effect on drinking was reported to be
significant at 3 and 6 months (p<0.01). Significance of the effect size for the intervention effect
on perceived norms was not reported.
Smoking cessation. When evaluating behavior change regarding smoking cessation, An et
al. 53 found that an online college life magazine providing personalized smoking cessation
messages and peer email support (the RealU intervention) was associated with a higher self-
reported 30-day abstinence rate among college smokers when compared to a control group
(p<0.001) . There was no difference reported between study groups for self-reported 6-month
prolonged abstinence, however (Appendix G, Evidence Table 16).
Strecher et al71 evaluated the effectiveness of web-based smoking cessation programs with
experimentally manipulated depth of tailoring. The research team used the term “tailoring” to
refer to a process consisting of 1) assessment of individual characteristics relevant to smoking
cessation, 2) algorithms that use the assessment data to generate intervention messages relevant
to the specific needs of the user, 3) a feedback protocol that delivers these messages to the
participant in a clear format. The intervention was a web-based smoking cessation program plus
nicotine patch with use of tailoring depth of the intervention based on five randomized
components: high- versus low-depth tailored success story, outcome expectation, efficacy
expectation messages, high- versus low-personalized source, and multiple versus single exposure
to the intervention components. Although depth of tailoring with a web-based smoking cessation
program plus nicotine patch was shown to influence rates of point-prevalence abstinence at 6-
month follow-up, results were most significant for high- versus low-depth success story
(p<0.018) and high- versus low-personalization of message (p<0.039) (Appendix G, Evidence
Table 16).
In another study, Strecher et al72 investigated the effects of a web-based computer-tailored
smoking cessation program (CQ Plan) as compared to an intervention of nontailored web-based
cessation materials (CONTROL) among nicotine patch users. Significant effects for increased
rates of ten-week continuous abstinence at 12 week follow-up were seen with the CQ Plan
intervention when the study groups were stratified according to presence or absence of tobacco-
related illness (p<0.001 and p<0.05, respectively), presence or absence of non-smoking children
in the household (p<0.001 and p<0.10, respectively), and frequency of alcohol consumption of
greater than three times per week as compared to less than three times per week among
participants (p<0.001 and p<0.10, respectively) (Appendix G, Evidence Table 16).
A third study by Strecher et al 74 found that an intervention of web-based tailored behavioral
smoking cessation materials was more effective than a control of web-based non-tailored
materials. Outcomes of 28-day continuous abstinence rates at 6 weeks and 10-week continuous
abstinence rates at 12 weeks were more strongly associated with the intervention group (p<0.008
and p<0.0004, respectively) (Appendix G, Evidence Table 16).
Strecher et al75 also evaluated the impact of computer tailored smoking cessation letters on
smoking cessation behaviors among a group patients (n=51) recruited from a family practice
clinic in North Carolina. At four month follow up smoking cessation rates differed significantly
in the computer tailored group among patients who smoked less than 1 pack per day (p<0.05).
No difference was seen among those who smoked more than 1 pack per day. In a similar study of
a larger sample (n=1484) reported in the same paper again found significantly higher smoking
cessation rates at 6 months follow up only among those who smoked less than one pack per day
(p<0.05) (Appendix G, Evidence Table 16).
46
One additional study by Strecher et al73 evaluated the efficacy of adding computer tailored
letters to an established telephone based smoking cessation intervention. At 12 month follow up,
the intervention failed to produce any additional impact on smoking cessation rates as compared
to quitline only controls.
Severson et al. 67 found that an interactive, tailored web-based intervention (Enhanced
Condition) when compared to a more linear, text-based website (Basic condition) was more
effective for cessation of all forms of tobacco use as well as specifically for smokeless tobacco
use at 3 and 6 months (p<0.001) (Appendix G, Evidence Table 16).
Schumann et al.70 investigated a computer-tailored transthoretical model-based smoking
cessation intervention in a general population setting in Germany and found the intervention to
be ineffective (Appendix G, Evidence Table 16).
Japuntich et al.64investigated an internet-based intervention as an adjuvant treatment in a
smoking cessation program as compared to a control group of pharmaceutical treatment and
counseling alone and did not find significant intergroup effects (Appendix G, Evidence Table
16).
Patten et al.54 found an internet-based intervention when compared to a brief office
intervention did not produce significant treatment differences for smoking abstinence rates
among adolescent study participants (Appendix G, Evidence Table 16).
Swartz et al 76investigated a video-based internet site presenting strategies for smoking
cessation and motivational materials tailored to the user’s race/ethnicity, sex, and age. Rates of
abstinence at 90-day follow-up were measured for participants using this intervention and
compared with abstinence rates among participants using the control intervention of a 90-day
wait period prior to accessing the internet program. Greater abstinence rates were associated
with the intervention group as compared to the control group, using both complete case analysis
(p<0.002) as well as intent-to-treat analysis (p<0.015). (Appendix G, Evidence Table 16).
Shiffman et al.68 investigated the effects of computer-tailored materials offered to purchasers
of nicotine polacrilex gum in the Committed Quitters Program (CQP) compared to the use of a
brief untailored user’s guide and audiotape in the starter package of the nicotine polacrilex gum .
Outcomes of 28-day continuous abstinence rates at 6 weeks and 10-week continuous abstinence
rates at 12 weeks were more strongly associated with the intervention group (p<0.001)
Dijkstra et al.62 evaluated the efficacy of computerized smoking cessation messages that were
either personalized, adapted or provided with personal feedback on smoking cessation rates at
four months. Results of this investigation indicate that significantly higher rates of cessation
were achieved in the personalization and feedback groups as compared to controls (p>0.05)
Hang et al77 investigated the value of using individualized text messaging (short message
service (SMS) for continuous individual support of smoking cessation among young adults. Post
intervention analysis revealed no significant effect of text messaging on smoking behavior
Brendryen et al60 sought to evaluate a multicomponent, one year smoking cessation
intervention delivered via the Internet and cell phone and consisting of email contacts, Web
pages, interactive voice response, text messaging technology and a craving telephone helpline.
The results indicate that the intervention group achieved statistically significantly higher
abstinence rates than control participants (20 percent versus 7 percent, odds ratio [OR] = 3.43, 95
percent CI = 1.60-7.34, p=0.002) (Appendix G, Evidence Table 16).
47
Prokhorov et al66 evaluated the long term efficacy of a CD ROM based smoking initiation
prevention program among urban inner city adolescents. The CD ROM contained embedded
animations, video, and interactive activities and was composed of five weekly sessions in one
semester and two ‘‘booster’’ sessions in the following semester (each 30 min in duration). At the
beginning of each session, students were given a series of activities that were tailored to their
stage of intention and designed to promote smoking cessation or reduced likelihood of initiation
(for nonsmokers). At 18-month follow-up, smoking initiation rates were significantly lower in
the intervention group compared to control (1.9 percent vs. 5.8 percent, p=0.05) (Appendix G,
Evidence Table 16).
Schumann et al69 evaluated a CHI application that involved up to 3 individualized feedback
letters generated by special computerized expert-system software and additional stage-tailored
self-help booklets. This intervention failed to demonstrate any significant effect on smoking rates
Prochaska et al65 compared standardized self-help manuals, individualized manuals, an
interactive computer system plus individualized manuals or personalized counselor calls plus
manuals. As compared to the standardized self help manual control group the interactive
computer group had a significantly larger impact on point prevalence abstinence than all other
groups at 6 months (p<0.05), 12 months (p<0.05) and 18 months (p<0.05). The interactive
computer group also significantly improved prolonged abstinence rates at 18 months (p<0.05)
Schneider 78 et al) tested the efficacy of an online personalized, comprehensive behavioral
smoking cessation forum offered through a commercial computer networking business. The
intervention was an asynchronous chat/discussion group moderated by a psychologist, a
psychiatrist, and a lay ex-smoker. The results of this investigation indicated that the intervention
did not significantly improve smoking cessation rates as compared to no intervention controls.
Curry et al61 compared the efficacy three treatments on smoking cessation behavior: a self-
help booklet alone; a self-help booklet with computer-generated personalized feedback; and a
self-help booklet, personalized feedback, and outreach telephone counseling. Salivary cotinine
levels were obtained to validate self reports at 12 month follow up. At three month follow up
only the telephone counseling group achieved significantly higher 7 day cessation rates as
compared to controls (p=0.02) (Appendix G, Evidence Table 16).
Obesity
Eleven studies evaluated the impact of CHI applications on intermediate outcomes related to
obesity (Table 9). The studies mostly addressed middle-class consumers across the United States
(US) and United Kingdom (UK), while one study targeted lower socioeconomic status school
children. The interventions often employed online, Web based technical platforms. In addition,
one study employed a pocket computer device and another used a laptop computer. No
application had a large effect on improving weight-loss behavior, weight change, or body
composition. The quality of the studies investigating obesity was variable with Jadad study
quality scores 4 ranging from moderately high (one study) to low. (Appendix G, Evidence Table
1)
48
Several studies employed Internet-based technical platforms while one study employed a
pocket computer device and another utilized a laptop computer. Educational content used in the
applications was custom designed by the investigators based on a range of Theoretic models:
Precaution Adoption Process Model Theory of Planned Behavior,79,80 evidence from obesity
research,81 and behavioral family-based treatment.82,83 Other sites listed their features: social
support,84 ethnic-related sources,83 or self-monitoring food exercises85 (Appendix G, Evidence
Tables 17-19). The overall strengths of the body of this evidence (Table 10) was graded as
moderate based on a modified version of the GRADE criteria5 and Chapter 11 of the EPC
Manual.6

Eleven studies evaluated several domains of CHI impact on obesity. Enrolled study
participants included adults (18-65) 80 middle-aged consumers81,84-87 teenagers, 83 school aged
adolescents,88 overweight women89,90 and overweight/obese men.91 Several studies were
restricted to consumers already obese on the basis of body mass index (BMI).80 In terms of
race/ethnicity,81,83-86 studies enrolled American populations, European,91 British81 and Dutch80
consumers. One study targeted African-Americans83 and another targeted primarily African-
Americans and Hispanics88 (Appendix G, Evidence Tables 17-19).

Across studies, the average age of enrolled consumers was early 40s. Williamson et al83
however, recruited teens with an average age of 13 years (SD 1.4), and Frenn88 recruited middle-
school seventh graders aged 12-14. Five studies80,88-90 targeted either predominately female or
only female consumers. One study targeted only males. 91 In terms of educational levels, the
Kroeze et al80 study included participants who had the following distribution of educational
attainment (tertiary 42 percent, higher secondary 37 percent, the remainder below that). A study
by Hunter et al enrolled mostly Caucasian participants while Frenn’s study enrolled
approximately 30 percent African-American and 30 percent Hispanics (Appendix G, Evidence
Tables 17 and 18).
49
Table 9. Results of studies on CHI applications impacting intermediate outcomes related to
obesity (N=11).

condition N Author, year Interventions Primary outcomes measured Applications*
Obesity 11 Booth, 200887 On-line weight Weight change +
reduction Waist circumference change 0
program Physical activity 0
including Energy intake 0
dietary advice
plus exercise
Exercise only
program
Burnett-Kent, Computer Short term weight change: Baseline 2 0
90
1985 Assisted wk period
method of Short term weight change: Post- +
providing baseline 8 wk period
feedback Long term weight changes (24 wks) +
Long term weight changes (40 wks) +
Self-reported Caloric intake +
Self-reported physical activity +
Cussler, Internet group Weight change 0
86
2008 BMI 0
Exercise energy expenditure 0
Energy intake 0
Frenn, 200588 Internet based Physical Activity +
interactive
Diet +
model
Hunter, Behavioral Body weight +
2008‡85 Internet BMI +
treatment(BIT)
Waist circumference +
Body fat percentage +
Kroeze, 2008 Interactive - Total fat intake +
†80
tailored Saturated fat intake 0
condition Energy intake +
Print - tailored
condition
McConnon, Internet BMI change at 12 months 0
81
2007 intervention Loss of 5% or more body weight (12 0
months)
50
Table 9. Results of studies on CHI applications impacting intermediate outcomes related to
obesity (N=11) (continued).

Obesity Morgan , Internet-based Physical activity +
(continued) 200991 weight-loss (mean steps/day) 3 months
program Physical activity +
(mean steps/day) 6 months
Energy intake (kJ/day) 3 months +
Energy intake (kJ/day) 6 months +
Taylor, 199189 Computer Weight Loss (Post-treatment 12weeks – 0
Assisted Pretreatment)
Therapy Weight Loss (followup at 6months – 0
Pretreatment)
Williamson, Interactive Body weight +
§83
2006 nutrition Body composition +
education Weight loss behavior 0
program and BMI +
Internet
counseling
behavioral
therapy for the
intervention
group
Womble, ediets.com Weight change percent ‐
2004║84 Weight change (kg) ‐
†
positive impacts (where indicated) only at 3months post-intervention, at 6 months post-intervention all impacts were
insignificant
‡
A positive impact indicates a decrease in any of the four listed outcomes
§
positive impacts (where indicated) only at 12 months post-intervention, at 24 months post-intervention all impacts were
insignificant
║
A negative impact indicates an increase in any of the two listed outcomes
BMI=body mass index; kJ/day = kilojoules per day; kg = kilogram; wk = week
51
obesity.
y (-1); n (0)
y (-1); n (0)
outcome?
†
‡
low (-2).
Outcomes
Weight-loss behavior. Williamson et al83 presented graphs on dieting change, exercise
change, overeating change, and avoidance of fat food change, none of which favored the
intervention, in either the teens or their parents. Cussler et al86 similarly showed equivalent
exercise energy expenditure in controls (mean164 [kcal/day], SD 268[kcal/day]) and
interventions (mean 123 [kcal/day], SD 265 [kcal/day]) and equivalent change in energy intakes
of 91 kcal/day (SD 33) and 74 kcal/day (SD 371) in the two groups, respectively. Kroeze and
colleagues80 measured food intake and found a decrease at 1 month equal to or greater than the
effect of a printed resource. For instance, for total fat intake, the regression-coefficient
confidence intervals (CIs) were (-18.6, -3.23) and (-15.59, -0.04) respectively. There were
similar effects for saturated fat and energy. The effects were statistically indistinguishable from 0
at 6 months. Print resources were more effective for high-risk consumers, with effects lasting 6
months, and with the Internet group showing no statistically significant improvement. Booth et
al87 measured weight-loss behavior through changes in physical activity (number of steps
counted per day) and changes in energy intake. Both the exercise-only and the online exercise
and diet advice groups showed a significant increase in the number of daily steps taken. Both
groups showed a decrease in energy intake at the 12-week measuring period, but the differences
were not significant. Frenn et al 88 demonstrated a significant improvement in physical activity
and significant reductions in dietary fat intake from an 8-session interactive Web-based
intervention (p=0.05). Burnett-Kent et al90 found that a laptop based computer assisted therapy
system could enable participants to achieve a significantly higher mean weight loss at 8 week
follow up (p<0.05) as compared to controls not using the computer assisted therapy system. The
effect size was reported to be rm =0.75. The significant enhancement of weight loss by the
computer assisted therapy was also found at 24 and 40 months (p<0.2 and p<0.5 respectively).
Effect sizes were not reported for these longer term findings. The computer system did not have
52
a significant effect on self-reported caloric intake and physical activity. Finally Morgan et al91
demonstrated a significant increase in physical activity and significant reductions in energy
intake as compared to baseline in both the Internet based program and information session and
program booklet as well as the information session and program-booklet-only control group at
the 6-month followup (Appendix G, Evidence Table 19).
Weight change. Cussler et al86 showed no difference in weight change: 1 kg (SD 4.6) loss
for control, 0.7 kg (5.4) loss for the intervention. Hunter et al85 documented a statistically
significant difference in BMI change: in the internet group , a decrease of 1.3 kg/m2 at 6 months,
with an increase in the control groups of 0.5 kg/m2 (initial BMI ≥ 27 kg/m2) and 0.9 kg/m2
(initial BMI ≤ 27 kg/m2) (p value not stated). Womble et al84 reported percent change in weight
from baseline. Again, the effects were small (1-4 percent), with overlapping confidence intervals.
Four studies reported BMI changes. Cussler et al86 reported identical changes of 2 kg/m2 at 4 and
at 16 months. Hunter et al85 also showed no change in BMI at 6 months (change statistically
indistinguishable from 0 and overlapping CIs). McConnon et al81 reported a mean change of 0.3
kg/m2 (CI -0.5 to 1 kg/m2, p=0.4) in favor of the Internet intervention, but not statistically
significant. Williamson et al83 also found a change of about 1 kg/m2 for the two groups (1.2
kg/m2 loss for the control group, 0.73 kg/m2 loss for the intervention group, statistically not
significantly different from each other) that became statistically nonsignificant at 18 months.
Booth 87 reported that weight change in the exercise-only group had a higher percentage weight
loss than online diet and exercise program group at 12 weeks; the difference between the two
groups was not significant. Taylor et al89 found no effect of a computer-assisted therapy
application on weight loss at 12 weeks or at the 6-month followup. Finally, Morgan et al91 found
significant increases in weight loss from baseline in the Internet-based program and information
session and program booklet as well as the information session and program-booklet-only
control group at the 6-month followup (Appendix G, Evidence Table 19).
Body composition. Hunter et al85 reported on body fat percentages. These, too, showed no
difference between the control group (mean 34.7, SD 7.0) and the intervention group (mean 33.9,
SD 7.3) at 6 months. Similarly, Williamson and colleagues83 reported an increase in body fat, as
measured by dual-energy x-ray absorptiometry (DXA), of 0.84 percent (SD 0.72) for the control
group and a decrease of 0.08 percent (SD 0.71) for the intervention group. Results of the Booth
study87 found the exercise-only group had a greater change in waist circumference, but the
difference between the two groups was not significant. Finally, Morgan et al demonstrated
significant changes in body weight, waist circumference, and BMI as compared to baseline in
both the Internet-based program plus information session and program booklet as well as the
information session and program-booklet-only control group at the 6-month followup (Appendix
G, Evidence Table 19).
53
Diabetes
Summary of Findings
Seven studies examined the effect of a CHI application on intermediate outcomes such as
health knowledge and health behavior in people with diabetes mellitus (Table 11). One of the
seven studies also included patients with heart disease and chronic lung disease. All studies were
RCTs, but the studies had low study quality scores and did not always directly address one of our
key questions. The findings were inconsistent across studies regarding the impact of a CHI
application on intermediate outcomes related to diabetes, with four studies suggesting a benefit
in terms of self-care, knowledge, physical activity adherence and satisfaction and three other
studies indicating mostly a lack of benefit (Appendix G, Evidence Table 1).

Seven studies evaluated a wide range of effects of CHI applications on intermediate
outcomes related to diabetes (Appendix G, Evidence Tables 20-22). All studies were RCTs, but
the comparisons being made were not all directly relevant to our key question. All seven of the
studies received low to very low study quality scores. This is a result of the difficulty in blinding
participants, and often investigators, regarding the assignment to the control and intervention
groups. Additionally, one study did not explain withdrawals.4 The overall strength of the body of
this evidence (Table 12) was graded as low based on a modified version of the GRADE criteria5
and Chapter 11 of the EPC Manual.6

Four of the studies were limited to type 2 diabetes, one was limited to gestational diabetes,92
and two included both type 1 and type 2 diabetes.93,94 Four of the studies evaluated an interactive
consumer Web site,92,93,95,96 two evaluated a personal monitoring and feedback device,39,97
Another study evaluated an interactive computer program.94 Comparisons were generally made
between a control group and an intervention group that was exposed to a CHI application.
However, in the study by Wangberg,93 both groups received an Internet-based intervention, with
one group receiving an intervention targeted at the area of self-care for which reported self-
efficacy was lowest, and the other group receiving an intervention targeted at the area of self-
care for which reported self-efficacy was highest (Appendix G, Evidence tables 20 and 21).
54
Table 11. Results of studies on CHI applications impacting intermediate outcomes in diabetes
(N=6).

condition N Author, year Interventions Primary outcomes measured applications*
Diabetes 6 Glasgow, Tailored self- Kristal Fat and Fiber Behavior scale -
200397 management
Homko, 200792 Telemedicine Self-efficacy (Diabetes Empowerment +
Scale (DES))
Satisfaction and readiness to change +
McKay, 200195 Internet-based Moderate-to-vigorous exercise 0
physical activity Walking 0
intervention
Richardson, Computerized Total Step +
200739 feedback Bout Steps +
mechanism Satisfaction +
Usefulness +
Adherence (Likelihood of wearing a +
pedometer)
Adherence (Mean hours of wearing a +
pedometer)
Wangberg, Low self- Summary of Diabetes Self Care +
2006†93 efficacy Activities
Perceived competence scale -
High self- Minutes activity per day 0
efficacy
Wise, 198694 Interactive Knowledge score +
computer
assessment
Diabetes 1 Lorig, 2006‡96 Online Change in health distress (0-5) +
with with intervention Change in self-reported global health(0- 0
heart 5)
disease Change in illness intrusiveness 0
and chronic Change in self-efficacy 0
lung
disease
†
study compares CHI targeting low self-efficacy items with CHI targeting high self-efficacy items: (+) indicates that there was
an increase in self efficacy in both groups; (-) indicates a decrease in both groups
‡
study measures the use of a personal monitoring device with tailored self –management compared with no tailored self-
management
55
diabetes.
3 Did the studies have important inconsistency? -1
y (-1); n (0)
y (-1); n (0)
outcome?
†
‡
low (-2).
Outcomes
Self-efficacy, self-care, and self-management. Homko et al evaluated the feasibility of
monitoring glucose control in indigent women with gestational diabetes mellitus (GDM) over the
Internet. Women with GDM were randomized to either the Internet group (n=32) or the
control group (n = 25). Patients in the Internet group were provided with computers and/or
Internet access if needed. A Web site was established for documentation of glucose values and
communication between the patient and the health care team. Women in the control group
maintained paper logbooks. The results of this study indicate that women in the Internet group
demonstrated significantly higher feelings of self-efficacy at the study’s end 92 (Appendix G,
Evidence Table 22).
In the Wangberg study,93 the author assessed whether self-efficacy(SE) could function as a
moderator of the effect of a tailored Internet-based intervention aimed at increasing self-reported
diabetes self-care behaviors. There was a significant overall main effect of the intervention on
self-care, F(1,25) = 5.56, p=0.026. A significant interaction between change in self-care and
baseline self-efficacy was found, F(1,25) = 4.67, p=0.040, with lower baseline self-efficacy
being related to greater improvements in self-care. A significant interaction between time and
gender was observed, F(1,25) = 4.78, p=0.038, with men having greater improvements in self-
care than women93 (Appendix G, Evidence Table 22).
Lorig et al96 evaluated the impact on self-efficacy of an Internet-based tailored chronic
disease self-management program. The results indicate that the intervention group increased their
self-efficacy significantly more than controls (0.40 [SD 1.98] p=0.051) This study also found
that the mean Health Distress Score decreased significantly more in the intervention group
(0.377 [SD 1.11] p=0.013) compared to controls96
Wise et al94 compared the effects of an interactive computer program, graphic animations and
personalized feedback vs. knowledge assessment and printed feedback vs. knowledge assessment
56
alone on knowledge and insulin control among insulin dependant and non insulin dependant
diabetics (IDDM and NIDDM respectively). Among IDDM patients at 4-6 month follow up the
printed feedback group and the computer program group showed significant increased in
knowledge (p<0.05 and p<0.01 respectively). The same was also true among NIDDM patients
(0<0.1 and p<0.05 respectively). In terms of glucose control all three treatment groups resulted
in significant reductions in HbA1c (knowledge assessment only [9.1± 0.2 percent to 8.4±0.1
percent, p<0.05], knowledge assessment and feedback [9.3±to 8.1±0.4 percent, p<0.05] and
interactive computer program [9.3±0.2 percent to 8.6±0.3 percent, p<0.05 percent]). Finally
among NIDDM patients significant reductions in HbA1c were only seen in the knowledge
assessment group and the feedback groups (knowledge assessment [9.6±0.4 percent to 8.8±0.3
percent, p<0.05] and feedback [9.2±0.4 percent to 7.9±0.4 percent, p<0.01]) (Appendix G,
Evidence Table 22).
Physical activity. McKay et al95 evaluated an Internet-based supplement (D-Net) to usual
care that focused on providing support for sedentary patients with type 2 diabetes to increase
their physical activity levels. The intervention group received goal-setting and personalized
feedback, identified and developed strategies to overcome barriers, received and could post
messages to an online “personal coach,” and were invited to participate in peer group support
areas. Results of this intervention indicate a significant increase in moderate to vigorous physical
activity (minutes/day) (p<0.001) and walking (minutes/day) (p<0.001).95 In a 10-month followup
evaluation of the McKay intervention (D-Net), the data indicate significant improvements in the
intervention group for physical activity (p<0.000)97 (Appendix G, Evidence Table 22).
A study by Richardson39 evaluated a pedometer hooked up to interactive computer-based
feedback. The study failed to demonstrate an effect on actual steps taken, but did demonstrate a
significant effect on patient satisfaction (p=0.006), usefulness (p=0.03), likelihood of wearing a
pedometer (p=<0.001), and mean hours of wearing a pedometer (p=0.038) (Appendix G,
Evidence Table 22).
Dietary habits. Glasgow et al97reports on additional dietary outcomes using the D-Net
intervention described by McKay et al above. 10 month follow up evaluation of the intervention
indicate significant improvements on the Kristal Fat and Fiber Behavior (FFB) scale
(P<0.000), in daily dietary fat consumption (p<0.000), CES-D Depression scale scores
(p<0.000), total cholesterol (p<0.000), LDL cholesterol (p<0.000), triglycerides (p<0.000) and
Lipid ratios (p<0.000). The intervention did not significantly improve HDL cholesterol or
HbA1c levels. (Appendix G, Evidence Table 22).
Mental Health
Eight studies evaluated the impact of CHI applications on intermediate outcomes in

mental health (Table 13). Studies evaluated the impact of CHI on three broad aspects of mental
health. These included: 1) depression/anxiety, 2) phobia, and 3) stress. Across the three domains
of mental health, the scientific evidence suggested that CHI applications may have a beneficial
57
Table 13. Results of studies on CHI applications impacting intermediate outcomes of mental
health (N=8).

condition N Author, year Interventions Primary outcomes measured applications
Depression/ 4 Christensen, Blue Pages: Center for Epidemiologic depression +
anxiety 200499 Web site scale
Automatic thoughts +
MoodGYM: Medical literacy +
Computer Psychological literacy +
based CBT Lifestyle literacy +
Cognitive behavior therapy literacy +
Neil, 2009106 MoodGYM Warpy thoughts score
internet-based No. of exercises completed (0—28) +
CBT
Proudfoot, Computerized Depression (BDI) +

200498 Therapy Anxiety (BAI) +
Work and Social Adjustment scale +
ASQ,CoNeg +
ASQ,CoPos +
Warmerdam, Interactive Depression (CES – D) +
107
2008 computer tool Anxiety using HADS +
based on CBT QoL using EQ5D +
Depression (CES – D) Proportion reaching 0
clinically significant change
Phobia 1 Schneider, Computer Main Problem(self-rating) +
108
2005 aided cognitive Main Goal(self-rating) +
behavior
therapy with
self-help
exposure
Stress 2 Chiauzzi, MyStudent Perceived Stress Scale 0
2008101 Body–Stress
Hasson, Web-based Self-rated stress management +
2005100 stress Self rated sleep quality +
management Self rated mental energy +
system Self rated concentration ability +
Self rated social support +
Biological marker +
Stress 1 Zetterqvist , Interactive self Perceived Stress Scale
management 2003105 help stress Hospital Anxiety and Depression Scale +
management HADS
program Anxiety +
Depression +
LE (Life Events) (Holmes and Rahes 0
Scale)
Perceived Social Support PS-family 0
Perceived Social Support PS-friends 0
ASQ=Attributional style questionnaire; BAI=Beck anxiety inventory; BDI= Beck depression inventory; CBT=cognitive
behavioral therapy; CoNeg=composite index for negative situations; CoPos=composite index for positive situations; CES–D =
Center for Epidemiologic Studies Depression Scale; EQ5D = EuroQoL; HADS = Hospital Anxiety and Depression Scale; QoL =
quality of life; PS+ perceived social support system
58
mental health.
y (-1); n (0)
y (-1); n (0)
outcome?
†
‡
low (-2).
effect on depression/anxiety, phobias, and stress (Table 14, and Appendix G, Evidence Tables
23-25).

The volume of the literature in this area was small. Four studies evaluated several domains of
CHI impact on intermediate outcomes related to depression or anxiety, 98,99 two studies evaluated
the impact on stress,100 one evaluated the impact on stress management, and 101one study
evaluated the impact on social phobia102 (Appendix G, Evidence Tables 23-25). The quality of
these eight trials was variable, ranging from moderate to very low study quality scores,4 with
several studies lacking in one or more methodological domains of RCT quality as measured by
the Jadad criteria (Appendix G, Evidence Table 1). Postintervention evaluations ranged from as
little as 1 month to as many as 6 months. The overall strength of the body of this evidence (Table
14) was graded as low, based on a modified version of the GRADE criteria5 and Chapter 11 of
the EPC Manual.6

These studies involved predominately married or cohabitating female adults of varying race
and ethnicities. They ranged from 13 to 75 years of age with widely varying educational
backgrounds. Outcomes of interest included impact on depressive symptoms,98 99 103,104 impact
on anxiety levels, 98,103,104 change in the degree to which problems affect one’s ability to conduct
normal activities,98 impact on dysfunctional thoughts,99 improvements in knowledge of therapy
including cognitive-behavioral theory (CBT),99 changes in perceived stress scores,101 self-rated
self-management,100,105 self-rated sleep quality,100 self-rated mental energy,100 self-rated
concentration,100 self-rated social support,100 quality of life, 104 and change in measured biologic
59
marker levels.100 Samples sizes were relatively small, ranging from 78101 to 182100 subjects per
arm of the study (Appendix G, Evidence Tables 23 and 24).
Outcomes
Depression/anxiety. Proudfoot et al98 evaluated the impact of Web-based cognitive-
behavioral therapy (CBT) on patients with diagnoses of depression, anxiety, and/or mixed
depression with anxiety. Use of the “Beating the Blues” online CBT intervention was associated
with improvements on the Beck depression inventory (BDI) (p=0.0006),98 Beck anxiety
inventory (BAI) (p=0.06),98 Work and Social Adjustment Scale (p=0.002),98 and Attributional
Style questionnaire (p<0.001 for negative situations and p<0.008 for positive situations).98
Christensen et al99 also evaluated the impact of a Web-based CBT application among patients
who scored above 22 on the Kessler psychological distress scale and who were not currently
receiving any treatment. The MoodGYM CBT intervention was associated with improvements in
depressive symptoms on the CES-D scores (p=0.05) and dysfunctional thoughts via the
Automatic Thoughts Questionnaire (p=0.05) compared to controls (Appendix G, Evidence Table
25).
Neil et al106 evaluated the impact of adherence to interactive consumer Web site-based
therapy among depressed and/or anxious youth. The first adolescent sample consisted of 1000
school students who completed the MoodGYM program in a classroom setting over five weeks
as part of n RCT. The second sample consisted of 7207 adolescents who accessed the
MoodGYM program spontaneously and directly through the open Web-based access. The results
of this evaluation indicate that adolescents in the school-based sample completed significantly
more online exercises (mean = 9.38, SD = 6.84) than adolescents in the open-access community
sample (mean = 3.10, SD = 3.85; t1088.62= −28.39, p<0.001).
Warmerdam et al 107 evaluated the effectiveness of Internet-based Cognative Behaviroal
Therapy (CBT) vs. Internet-based Problem Solving Therapy (PST) on Depressive symptoms
among community dwelling adults. Outcomes were evaluated at 5, 8 and 12 weeks post
intervention. The results indicate significant improvements in between-group effect sizes for
depressive symptoms, 0.54 for CBT after 8 weeks (95 percent confidence interval (CI): 0.25 -
0.84) and 0.47 for PST after 5 weeks (95 percent CI: 0.17 - 0.77) as compared to wait list
controls. These effects were further improved at 12 weeks in both treatment groups (CBT: 0.69,
95 percent CI: 0.41 - 0.98; PST: 0.65, 95 percent CI: 0.36 - 0.95).
Phobia. FearFighter is an online CHI application designed to reduce symptoms of
phobia/panic disorders (agoraphobia, social phobia, and specific phobias). 108 In this study
FearFighter was compared to guided Internet-based self-help relaxation therapy (Managing
Anxiety group [MA]). Both arms also received periodic phone or email followup from a
therapist. At 1 month, patients in the FearFighter group scored better than those in the MA group
on several phobia subscales as assessed by self-report and blinded raters using the main problems
and goals subscale (p<0.001), FQ global phobias subscale (p<0.001), and FQ global impression
score (p<0.001) (Appendix G, Evidence Table 25).
Stress. MyStudentBody is a Web-based CHI application, which is designed to reduce
symptoms of stress among college students. Chiauzzi et al101 evaluated the effects of this
application as compared to use of a control Web site and a non-Internet Web site control group.
No significance between group differences in perceived stress was detected at 6-month followup.
60
Hasson et al100 conducted an evaluation of a Web-based health promotion tool on mental and
physical well-being and stress-related biological markers. At 6-month postintervention followup,
the intervention group had improved significantly compared to the reference group on ratings of
ability to manage stress (p=0.001), sleep quality (p=0.04), mental energy (p=0.002),
concentration ability (p=0.038), and social support (p=0.049). The anabolic hormone
dehydroepiandosterone sulphate (DHEA-S) decreased significantly in the reference group as
compared to unchanged levels in the intervention group (p=0.04). Neuropeptide Y (NPY)
increased significantly (p=0.002), and Chromogranin A (CgA) decreased significantly in the
intervention group (p=0.001) as compared to the reference group, while tumor necrosis factor α
(TNFα) decreased significantly in the reference group compared to the intervention group
(p<0.016). These results were consistent with a beneficial effect of this CHI application on
several indicators of well-being and stress-related biomarkers (Appendix G, Evidence Table 25).
Zetterqvist et al 105 evaluated the effects of an internet-based self-help stress management
program. The program was entirely delivered via the internet and included applied relaxation,
problem solving, time management, and cognitive restructuring. The results of this investigation
indicate that no measureable intervention effect was found in that both the treatment and control
groups improved significantly at follow up in terms of perceived stress scores and the Hospital
Anxiety and Depression Scale. In addition, participant attrition was significant.
Asthma and Chronic Obstructive Pulmonary Disease

Three studies evaluated the impact of CHI applications on intermediate outcomes in
asthma8,10,109 and one in chronic obstructive pulmonary disease (COPD).110 Outcomes of interest
included adherence, change in behavior in relation to rescue inhaler availability, asthma
knowledge, change in asthma knowledge, dyspnea knowledge, and self-efficacy in managing
dyspnea (Table 15). Across these studies, the body of the scientific evidence suggested that most
CHI applications intended for use by individuals with asthma or COPD had variable results.
Significant changes were noticed in the areas of change in knowledge.

Overall the volume of the literature in this area is small. There were only three studies on
asthma and one on COPD. They evaluated several domains of CHI impact on intermediate
outcomes. Studies addressing intermediate outcomes in asthma had a wide range of study
participants, ranging from very low (<30 participants per arm)8 to low (>70 participants per
arm).10,109 The one study addressing intermediate outcomes of CHI applications on COPD had a
small sample size (<30 participants per arm)110(Appendix G, Evidence Tables 26-28). The
quality of these four trials was moderate to low. All studies lacked information on blinding, were
single blinded, and/or used inappropriate blinding methods as measured by the Jadad criteria4
(Appendix G, Evidence Table 1). Consumer postintervention evaluations ranged from as little as
12 weeks to as many as 6 months. The overall strength of the body of this evidence (Table 16)
was graded as low based on a modified version of the GRADE criteria5 and Chapter 11 of the
EPC Manual.6
61
Studies that evaluated the impact of CHI applications on asthma-related intermediate
outcomes looked at individuals under the age of 17 years, and/or their caregivers. The population
of interest in the study addressing COPD was much older–greater than 68 years old. Information
regarding gender across these studies was reported and can be found in Appendix G, Evidence
Table 26. Information on race/ethnicity was reported in only one study8 where the population
was identified as mainly white, non-Hispanic. The education level of participants (children) in
studies addressing asthma was not reported. In one study where caregivers were under
evaluation,10 over 50 percent of the caregivers had a high school diploma or below. The
education level of caregivers in the other study8 was not reported; education levels of the
children were reported, but were not of value for this report (Appendix G, Evidence Tables 26
and 27).
Outcomes
Adherence. The impact of CHI applications on adherence was measured in two of the three
articles addressing asthma. Jan et al10 evaluated Blue Angel for Asthma Kids, an Internet-based
interactive asthma educational and monitoring program. The intervention group was taught to
monitor their peak expiratory flows (PEF) and asthma symptoms daily on the Internet. The also
received an interactive response consisting of a self-management plan from the Blue Angel
monitoring program. The control group received a traditional asthma care plan consisting of a
written asthma diary supplemented with instructions for self-management. The results of this
study indicate that the intervention group experienced significantly decreased nighttime
(p=0.028) and daytime symptoms (p= 0.009); improved morning (p=0.017) and night peak
expiratory flow (p=0.010); increased adherence rates (p<0.05); improved well-controlled asthma
rates (p<0.05); improved knowledge regarding self-management (p<0.05); and improved quality
of life (p<0.05) when compared with conventional management.
Joseph et al109 evaluated a multimedia, Web-based asthma management program to
specifically target urban high school students. The program uses “tailoring,” in conjunction with
theory based models, to alter behavior through individualized health messages based on the
user’s beliefs, attitudes, and personal barriers to change. The control group was given access to a
generic asthma Website. The results of this investigation indicate that at 12 month follow up, the
intervention group reported fewer symptom-days (p= 0.003), fewer symptom-nights (p=0.009),
fewer school days missed (p=0.006), fewer restricted activity days (p=0.02) and fewer
hospitalizations for asthma (p=0.01) when compared with control (Appendix G, Evidence Table
28).
62
Table 15. Results of studies on CHI applications impacting intermediate outcomes in asthma and
COPD (N=4).

Asthma 3 Jan et al Asthma Monitoring adherence (peak flow meter 0
700710 education and technique score)
an interactive Monitoring adherence (asthma diary +
asthma entries per month)
monitoring Therapeutic adherence (DPI or MDI plus 0
system spacer technique score
Therapeutic adherence 0
Therapeutic adherence (adherence to 0
inhaled corticosteroid)
Joseph, et al “Puff City” Controller medication adherence: 0
109
2007 Internet Positive, no negative, or negative 0
intervention behavior change
Rescue inhaler availability: positive 0
behavior, no negative, or negative
behavior change
Krishna et al Internet- Asthma knowledge score (caregivers of +
20038 enabled children 0-6 17years old)
asthma Asthma knowledge score (caregivers of +
education children 7-17 17years old)
program Asthma knowledge score (children 7-17 +
17years old) †
Change in knowledge (caregivers of +
children 0-6 17years old) †
Change in knowledge (caregivers of +
children 7-17years old)
Change in knowledge (children 7- +
1717years old)
COPD 1 Nguyen et al Internet-based Dyspnea knowledge score (range 0-15 +
9
2008 dyspnea self- 17years old)
management Self-efficacy score for managing 0
dyspnea (range 0-10 17years old)
†
while the CHI application showed positive impact in knowledge scores across groups, the change in scores was most significant
in these two groups using the application
DPI=dry powder inhaler; MDI=metered dose inhaler
63
asthma/COPD.
y (-1); n (0)
y (-1); n (0)
outcome?
†
‡
low (-2).
Knowledge. Krishna et al8 evaluated whether health outcomes of children who have asthma
can be improved through the use of an Internet-enabled interactive multimedia asthma education
program. Children and caregivers in both the intervention and control groups received
traditional patient education. Intervention group participants also received self-management
education through the Interactive Multimedia Program for Asthma Control and Tracking.
Results indicate that the intervention significantly increased asthma knowledge of children
(p<0.001) as compared to controls.
Nguyen et al 111 measured the efficacy of an Internet-based and face-to-face self
management program in people living with COPD. The content of the two programs was similar,
focusing on education, skills training, and ongoing support for dyspnea self-management. The
only difference was the mode of administration (Internet/personal digital assistant (PDA) or face-
to-face) of the education sessions, reinforcement contacts, and peer interactions. The results
indicate that there were improvements in knowledge of dyspnea management strategies in both
groups, however there were no significant group by time differences. (Appendix G, Evidence
Table 28).
Self efficacy. Nguyen et al 111 also measured the efficacy of an Internet-based and face-to-
face self management program to increase self efficacy among people living with COPD. As
outlined above, the content of the two programs were similar, focusing on education, skills
training, and ongoing support for dyspnea self-management. The only difference was the mode
of administration (Internet/personal digital assistant [PDA] or face-to-face) of the education
sessions, reinforcement contacts, and peer interactions. The results indicate that there were
improvements in self-efficacy for managing dyspnea in both groups, however there were no
significant group by time differences (Appendix G, Evidence Table 28).
64
Miscellaneous Intermediate Outcomes
Sixteen studies evaluated the impact of CHI applications on intermediate outcomes across 13
other categorical diseases and health issues. These included cardiovascular disease,112,113
arthritis,114 back pain,115 behavioral risk factor management,116 cancer,15,117, caregiver decision-
making,118 health behavior change,119 headache,120 HIV/AIDS,121 menopause/hormone
replacement therapy (HRT),122,123 fall prevention,124 adolescent risk behavior, 125 and
contraception9 (Appendix G, Evidence Tables 29-31). Across these studies, the CHI applications
had varying effects on intermediate outcomes. The studies were too heterogeneous and the
volume of studies on any single topic too few to support a conclusion about the effectiveness of
CHI applications for these conditions.

The volume of the literature in this area is at a very early and incomplete stage of
development. With the exception of studies focusing on cardiovascular disease, cancer, and
menopause/HRT, which had two studies each, all other health issues had only one study
evaluating an intermediate outcome for that topic area (Appendix G, Evidence Tables 29-31).
The quality of these trials was variable with several studies lacking in one or more
methodological domains of RCT quality as measured by the Jadad criteria4 (Appendix G,
Evidence Table 1). The overall grade of this body of evidence was insufficient based on a
modified version of the GRADE criteria5 and Chapter 11 of the EPC Manual.6

Most of these studies involved adults of varying race and ethnicities, from 22 to 89 years of
age, with widely varying educational backgrounds. One study125 involved adolescent teens aged
13-17. Outcomes of interest included self-efficacy,112,114,124 medication compliance,126 activity
limitation,114 self-reported global health,114 arthritic pain,114 fat intake,116 physical activity,116
satisfaction with care,15 receipt of Pap smear,117 caregiver decisional confidence,118,121
decisionmaking skill,118,121 social isolation,118,121 preventive care uptake,119 headache
symptoms,120 depressive symptoms,120 anxiety,120 reduced health status decline,121
knowledge,9,122,123 satisfaction with decisions,122 reduced decisional conflict,122 realistic health
expectations,123 high cigarette use, frequent marijuana use, high alcohol use, problems at home,
often feeling sad or upset, feeling sad or down lately, taking meds, having a love interest, having
sex, desiring contraceptive information,125 and behavioral intention.127 Postintervention
followup time ranged from immediate postintervention to 1 year. Samples sizes were generally
small, ranging from 8 to 344 subjects per arm of the study, except for two larger studies which
had sample sizes of 827 and 930 in each arm,116 and 940 and1066 in each arm119 (Appendix G,
65
Outcomes
Adolescent risk behavior. Paperny et al125 evaluated the effect of a written Personalized
Health Risk Assesment (HRA) (controls) that is shared with a clinician to a computerized HRA
that was (intervention #2) or was not (intervention number 1) shared with a clinician. Over 75
percent of the participants were White or of Asian descent, 52 percent were males, and
approximately 10 percent were receiving financial assistance. The results indicated that
significant postintervention reductions in high cigarette use (p=<0.01/p=<0.03); reductions in
frequent marijuana use (p=<0.04/p=<0.03); reductions in problems with parents
(p=0.001/p=0.001); and reductions in often sad, upset, or unhappy feelings (p=0.001/p=0.007)
were achieved in both treatment groups (did not share computerized HRA with clinician/shared
computerized HRA with clinician) as compared to controls (written HRA shared with clinicians).
Significant reductions in high alcohol use (p=<0.02/NS), feeling sad or down lately
(p=<0.04/NS), and has a current lover (p=<0.03/NS) were only significant in the group that did
not share their HRA with the clinician. Finally there was no measureable effect of the
intervention on having sexual intercourse (NS/NS) or taking medications (NS/NS).
Arthritis. Lorig et al114 conducted an evaluation of an Internet-based arthritis self-
management program among patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia.
At 1-year postintervention, patients in the intervention group demonstrated significant
improvement in health distress (p< 0.001), activity limitation (p< 0.001), self-reported global
health (p=0.004), and pain (p<0.001) and self-efficacy (p=0.018). No impact was seen on health
care utilization or health behaviors (Appendix G, Evidence Table 31).
Back pain. Buhrman et al115 investigated the impact of an Internet-based cognitive-
behavioral intervention with telephone support for chronic back pain. At 3-month
postintervention followup evaluation there was significant improvement for several Coping
Strategies Subscale items including praying and hoping (p=0.032), catastrophizing (p=0.005),
control of pain (p<0.001), and ability to decrease pain (p<0.0001). In addition, significant
improvement was also found on Multidimensional Pain Inventory subscales for life control
(p<0.001) and decrease of punishing responses (p<0.05). Results on the Pain Impairment Rating
Scale showed a significant reduction (p<0.01), while a significant decrease was also found on the
Hospital and Anxiety Depression Scale (p<0.001) (Appendix G, Evidence Table 31).
Behavioral risk factor control. Oenema et al116 evaluated the impact of an Internet-
delivered, computer-tailored lifestyle intervention targeting saturated fat intake, physical activity
(PA), and smoking cessation. At 1-month postintervention followup the intervention group had a
significantly lower self-reported saturated fat intake (p<0.01) and a higher likelihood of meeting
the physical activity guidelines among respondents who were insufficiently active at baseline
(OR, 1.34, 95 percent CI, 1.001–1.80). No significant effects were found for self-reported
smoking status (Appendix G, Evidence Table 31).
Contraception. Chewning 9 et al conducted a study to evaluate a computer-based
contraceptive decision aid among young women. At 1-year postintervention followup,
intervention participants demonstrated higher oral contraceptive knowledge than controls
(p=0.00) (Appendix G, Evidence Table 31).
Cardiovascular disease. Kukafka et al112 investigated if a tailored, Web-based,
cardiovascular disease educational system could influence self-efficacy regarding a patient’s
likelihood of acting appropriately in response to acute myocardial infarction symptoms. At 3-
months postintervention followup evaluation, patients in the Web-based intervention arm of the
66
study demonstrated significant increases in self-efficacy to label symptom sensations (p<0.001),
self-efficacy to respond to symptom sensations (p<0.05), and cognitive control self-efficacy
(p<0.001) (Appendix G, Evidence Table 31).
Cancer. Jones et al15 conducted an investigation to compare the use and effect of a
computer-based personalized information system for cancer patients using each patient’s medical
record with a computer system providing only general information and with information
provided in booklets. At postintervention followup, patients in the personalized computer
intervention group were more likely to learn something new (p=0.03), thought that the
information was relevant (p=0.02), and had higher satisfaction scores (p=0.04) than patients in
the general computer information group. In addition, patients who used the printed booklets were
more likely to feel overwhelmed by the information (p<0.001) and felt that the information was
too limited (p<0.001). Finally, at 3-months postintervention, patients who used the printed
booklets were less likely to prefer the computer to a 10-minute, in-person consultation (p<0.001).
Campbell et al117 assessed the impact of computer-generated printed feedback on cervical
screening among women who were under-screened for cervical cancer. Significant 6-month
postintervention screening rates were demonstrated only among under-screened women between
50-70 years of age (p<0.5) (Appendix G, Evidence Table 31).
Caregiver decision. Brennan et al118 evaluated CompuLink, which is an online support
application, designed to enhance decisionmaking confidence and skill by provision of
information, decision-support tools, and communication (email). An evaluation of this
application documented an association between CompuLink and significantly improved
decisionmaking confidence (p<0.01). However no change was seen in terms of decisionmaking
skill, social isolation, or health status (Appendix G, Evidence Table 31).
Fall prevention. Yardley et al124 conducted an evaluation of an interactive Web-based
program that provides tailored advice about undertaking SBT activities among seniors 65-97
years of age. Postintervention evaluation suggests that there was a significant difference between
the tailored and control groups on ratings of the personal relevance of the advice (p =0.014), self-
efficacy for carrying out SBT (p=0.047), and intention to carry out strength and balance training
(p=0.039). The intervention did not exert any measurable effects on reports of the advice being
more suitable or interesting or expectation that the recommended activities would improve their
balance (Appendix G, Evidence Table 31).
Health behavior change. Harari et al119 conducted an RCT to evaluate the impact on health
behaviors and use of preventive health care services of a computer-generated, tailored, health
education system. At 1-year followup evaluation there were no significant differences in self-
reported health risk behavior, except for a small but statistically significant difference in
adherence with recommended levels of physical activity (at least 5 times per week moderate to
strenuous) (P = 0.03). In terms of preventive health care uptake, there was a significant increase
in pneumococcal vaccination rates (P=0.04) among patients enrolled in the computer-based
intervention (Appendix G, Evidence Table 31).
Headache. Devineni et al 120 evaluated an Internet-delivered behavioral intervention versus a
symptom monitoring waiting list control group among patients with chronic headache. Two-
month postintervention evaluations indicated significant reductions in headache index scores
(p<0.05). There were also significant improvements on the Headache Symptom Questionnaire
(p<0.01) and the Headache Disability Inventory (p<0.05) (Appendix G, Evidence Table 31).
67
HIV/AIDS. Brennan et al121 conducted a second study of CompuLink (see above) among
persons living with HIV/AIDS. This investigation suggested an association between using
CompuLink and reduced levels of social isolation (p<0.01) and improved decisionmaking
confidence (p<0.0). However no change was seen in terms of decisionmaking skill or health
status as compared to controls.
Menopause/HRT utilization. Shapira et al122 conducted an RCT of a computer-based
hormone therapy (HT) decision-aid versus print material among postmenopausal women. At 3-
months postintervention followup evaluation, there was no measurable difference between
groups with respect to knowledge, satisfaction with decision, decisional conflict, or hormone
therapy use. Rostom et al 123 conducted an investigation to compare the efficacy of a
computerized decision aid compared to an audio booklet among women considering long-term
HRT. The results of a postintervention evaluation indicated that the computerized decision aid
intervention significantly increased realistic expectations (p=0.015) and knowledge (p=0.019)
among women considering long term HRT (Appendix G, Evidence Table 31).
Key Question 1c: What evidence exists that consumer health

informatics applications impact relationship-centered
outcomes?
Eight studies evaluated the impact of CHI applications on various aspects of relationship-
centered outcomes (Tables 17 and 19, and Appendix G, Evidence Tables 32-34). Outcomes of
interest include social support, quality of life, health information competence, decision
confidence, improved decision making skill, reduced social isolation, level of positive interaction
with the provider, and satisfaction with care. These outcomes were examined in the context of
five health problems, which include breast cancer, caregiver decision making, osteoarthritis,
newborn birth and delivery, and HIV/AIDS. Across these studies, the body of the scientific
evidence indicated that most CHI applications evaluated to date had equivocal effects on
relationship-centered health outcomes.
68
Table 17. Studies of CHI applications impacting relationship-centered outcomes in women with
breast cancer (N=4).
Target
condition N Author, year Interventions Primary outcomes measured
Caregiver 1 Brennan, Experimental Decision confidence
decision making 1995118 Improved decision making skill
Isolation
HIV/AIDS 1 Flatley- Computer Link Improved decision making confidence
Brennan, Improved decision making skill
121
1998
Reduced social isolation
Differential decline in health status
Arthritis 1 Sciamanna, Patient satisfaction after Patient overall satisfaction score
131
2005 intervention with the osteoarthritis care they
are receiving
Satisfaction with care Peak consumption: max number of
drinks per drinking day
Vaginal or c- 1 Montgomery, Information DCS at followup
130
section delivery 2007 Difference between groups in total
Decision analysis score on DCS (decision vs.
usual care)
Odds ratio for caesarean (elective
& emergency) vs. vaginal
decision vs. usual care
Satisfaction with decision (decision
analysis vs. usual care)
Mode of delivery - elective
caesarean
Delivery - emergency caesarean
Delivery - vaginal birth
CHESS = Comprehensive Health Enhancement Support System; DCS= decisional conflict scale; IVD= interactive video disc system

Eight studies evaluated several domains of CHI impact on relationship-centered care
outcomes. With the exception of breast cancer, for which there were four studies regarding
relationship-centered outcomes,13,14,128,129 all other topics were evaluated by a single study:
HIV/AIDS,121 newborn delivery,130 osteoarthritis,131 and Alzheimer’s disease and caregiver
decisionmaking.118 Only one study130 was large, with 147 to 201 subjects per arm of the study;
all other studies relied on very small sample sizes (< 80 subjects per arm) (Appendix G,
Evidence Tables 32-34). The quality of these eight trials was variable with several studies
lacking in one or more methodological domains of RCT quality as measured by the Jadad4
criteria (Appendix G, Evidence Table 32-34). Patient postintervention evaluations ranged from
as little as 2 months to as many as 12 months. The overall strength of the body of this evidence
(Table 18) was graded as moderate for studies on breast cancer based on a modified version of
the GRADE criteria5 and Chapter 11 of the EPC Manual.6
69
Table 18. Grade of the body of evidence addressing CHI impact on relationship-centered
outcomes in breast cancer.
1 Protection against risk of bias (relates to study design, study quality, reporting bias Moderate
y (-1); n (0)
y (-1); n (0)
outcome?
†
‡
(high, moderate, low): if above score is (+), increase grade; if above score is (-), decrease grade from high to moderate (-1) or
low (-2).

The studies that were evaluations of the impact of CHI applications on relationship-centered
care generally were tested among an adult, non-elderly population. The mean age of study
participants across studies was 32 to 52 years. One additional study was among participants with
an average age of 64. Information regarding gender across these studies was generally not
reported. Because 4 of the studies were conducted in the context of breast cancer13,14,128,129 and a
fifth study was conducted in the context of newborn birth decision,130 it can be inferred that these
six studies were completely among female participants. Only six studies reported on the
race/ethnicity of study participants. Of these, 4 studies included only non-Hispanic white
participants. One additional study included whites and African Americans while a final study
included whites, African-Americans, Asian/Pacific Islanders and Hispanics (Appendix G,
Outcomes
Breast cancer. When evaluating social support, quality of life, and health confidence among
women with breast cancer, Gustafson et al14 found that the Comprehensive Health Enhancement
Support System (CHESS) provided significantly more social support (p=0.003) and enabled
greater quality of life (p=0.029) and health information competence (p=0.007) than Internet
access alone at 2 months. The effect of CHESS remained for social support (p=0.027) and
quality of life (p=0.047) at 4 months, while no effects of CHESS were observed at 9 months for
social support, quality of life, or health information confidence.
Gustafson13 also evaluated the effectiveness of the CHESS among younger underserved
women. At the 2-month postintervention followup, CHESS had significant impact on patient
70
information competence (p<0.05), level of comfort with the health care system (p<0.01), and
increased confidence in doctors (p<0.05).
Maslin et al129 studied the effectiveness of a shared decision making computer program
(interactive video disc) for women with early breast cancer contemplating surgical and
chemotherapeutic options. Use of the interactive video disk did not have significant effect on the
treatment decisions made by women participating in the study.
Green et al128 compared the effectiveness of counseling alone versus counseling preceded by
use of a computer-based decision aid among women referred to genetic counseling for a family
or personal history of breast cancer. Postintervention evaluations suggested that participants
rated 11 of 12 specific attributes of the effectiveness of the counseling sessions significantly
higher (P < 0.0001) compared with the counselors. Overall, computer program use resulted in
shorter face-to-face counseling sessions among women at low risk for carrying breast cancer
gene mutations (p=0.027) (Table 19, and Appendix G, Evidence Table 34).
Table 19. Results of studies on CHI applications impacting relationship-centered outcomes in

breast cancer (N=4).

condition N Author, year Interventions Primary outcomes measured Applications
Breast cancer 4 Green, Counseling Alter content of discussions +
2005128 and Computer Change the way they used their time +
Used time more efficiently +
Skip material typically present +
Effectiveness of counseling session +
Shorter counseling sessions +
Gustafson, Internet Social support +
14
2008 Quality of life +
CHESS Health competence +
Gustafson, CHESS Information competence +
200113 Participation +
Confidence in doctors +
Maslin, IVD shared Anxiety and depression +
129
1998 decision Satisfaction with treatment decision 0
making
CHESS = Comprehensive Health Enhancement Support System; IVD = interactive videodisc system
Caregiver decisionmaking (Alzheimer’s disease). CompuLink118is an online support

application designed to enhance decisionmaking confidence and skill by provision of
information, decision support tools, and communication (email). An evaluation of this
application documented an association between use of CompuLink and significantly improved
decisionmaking confidence (p<0.01). No change was seen in terms of decisionmaking skill,
social isolation, or health status (Appendix G, Evidence table 34).
HIV/AIDS. In another study of CompuLink 121 among persons living with HIV/AIDS, data
suggested an association between use of CompuLink and reduced levels of social isolation
(p<0.01) and improved decisionmaking confidence (p<0.0). No change was seen in terms of
decisionmaking skill or health status as compared to controls (Appendix G, Evidence table 34).
71
Osteoarthritis. Sciamanna et al131 evaluated the effect of a Web-based osteoarthritis
educational application on patients’ perceptions of the quality of their osteoarthritis care. This
application failed to produce a measurable effect on patient satisfaction with osteoarthritis care
as compared to controls (Appendix G, Evidence table 34).
Newborn delivery. Montgomery et al130 investigated the effects of two computer-based
decision aids (an information program and individualized decision analysis) on decisional
conflict and actual mode of delivery among a group of pregnant women with one previous
caesarean section. The results of this study indicate that there was no significant effect of either
of these computer-based decision aids on decisional conflict or mode of delivery (Appendix G,
Evidence table 34).
Key Question 1d: What evidence exists that consumer health

informatics applications impact clinical outcomes?
Breast Cancer
Three studies addressed the impact of CHI applications on breast cancer clinical outcomes.
Outcomes of interest include quality of life, well-being, physical functioning, and anxiety (Table
20). All three studies were RCTs and the quality of these studies varied from very low to low.
Across these studies the body of the scientific evidence suggests that CHI applications intended
for use by individuals with breast cancer have a neutral to positive impact.
Table 20. Results of studies on CHI applications impacting clinical outcomes in breast cancer
(N=3)

Breast 3 Gustafson, CHESS Social/family well being (quality of life) 0
Cancer 200113 Emotional well-being (quality of life) 0
Functional well-being (quality of life) 0
Breast cancer concerns (quality of life) 0
Gustafson, CHESS Quality of life 0
14
2008
Maslin, IVD shared Anxiety and depression† +
129
1998 decision Physical functioning +
programme
†
significant impact of CHI was seen in this outcome
CHESS= Comprehensive Health Enhancement Support System; IVD= interactive video disc system
72
Overall the volume of the literature in this area is small (three studies). Many domains of
CHI application impact on clinical outcomes with individuals with breast cancer were measured.
The three studies had low13 to very low14,129 numbers of study participants. Followup periods
were either shot (2 months) or not reported (Appendix G, Evidence Tables 35-37). None of the
studies contained any information on blinding as measured by the Jadad criteria4 (Appendix G,
Evidence Table 1). The overall strength of the body of this evidence (Table 21) was graded as
low based on a modified version of the GRADE criteria5 and Chapter 11 of the EPC Manual6

Studies that evaluated the impact of CHI applications on breast cancer clinical outcomes-
outcomes looked at individuals between the ages of 44 and 52; age was only reported in two
studies.14,129 Information regarding gender across these studies was not reported. Information on
race/ethnicity was reported in only in two studies as predominantly white, non-Hispanic. 14,129
(Appendix G, Evidence Tables 36 and 37).
Outcomes
To assess the impact of a computer-based patient support system on quality of life in younger
women with breast cancer, 246 newly diagnosed breast cancer patients under age 60 were
randomized to a control group or an experimental group that received Comprehensive Health
Enhancement Support System (CHESS), a home-based computer system providing information,
decision-making, and emotional support. At 5-month followup, no statistical difference was
shown in quality of life between the control and CHESS group.13 No significant improvement in
quality of life was demonstrated by the same authors in another study in 257 breast cancer
patients after 9-month followup.14
Another study evaluated the usefulness of a shared decisionmaking program for women with
early breast cancer; looking at surgical and adjuvant treatment options (chemotherapy) using a
personalized computerized interactive video system.129 One hundred patients were randomized to
an intervention group (n=51) or control group (n=49). The study showed improvement in the
following clinical outcomes: a significant fall in anxiety after 9 months measured by the Hospital
Anxiety and Depression Scale (p<0.001), improvement in the physical functioning sub-score of
general quality of life measured by the Medical Outcomes Study Short Form 36 questionnaire
(Table 22, and Appendix G, Evidence Table 37).
73
individuals with breast cancer.
1 Protection against risk of bias Low

y (-1); n (0)
4 Was there some (-1) or major (-2) uncertainty about the directness or extent to which the people, 0
interventions and outcomes are similar to those of interest?
y (-1); n (0)
6 Did the studies show strong evidence of association between intervention and outcome? 0
Overall grade of evidence‡ Very low
†
‡
low (-2).
Diabetes Mellitus
Three studies addressed the impact of CHI applications on clinical outcomes in individuals
with diabetes mellitus. Outcomes of interest were the use of insulin therapy, and measures of
hemoglobin A1c (HbA1c), total glucose, triglycerides, and fasting blood glucose. (Table 22) All
three studies were RCTs and the quality of these studies was low (Appendix G, Evidence Table
1). There was no indication of significant impact of the CHI application on outcomes in two
studies.92,132 One study94 showed a positive impact on HbA1c.

The volume of this literature is small. All three studies had a small number (<30)
participants. Followup periods ranged from 37 weeks92 to 12 months132 (Appendix G, Evidence
Tables 35-37). Blinding, as measured by the Jadad criteria,4 was not reported in any of the
studies (Appendix G, Evidence Table 1). The overall strength of the body of this evidence (Table
23) was graded as low based on a modified version of the GRADE criteria5 and Chapter 11 of
the EPC Manual6
74
Table 22. Results of studies on CHI applications impacting clinical outcomes in diabetes mellitus
(N=3).

Diabetes 3 Homko, Telemedicine Insulin therapy 0
200792 FBS 0
A1c at time of delivery 0
Tjam, 2006132 Individuals with A1C (%) 0
interactive FBG (MMOL/L) 0
Internet TC (MMOL/L 0
program TG (MMOL/L) 0
Wise et al 94 Interactive HbA1c +
computer
assessment
†
significant impact of CHI was seen in this outcome
FBG = fasting blood glucose; FBS = fasting blood sugar; HbA1c = hemoglobin A1c; MMOL/L = millimoles per litre;
TC = total cholesterol; TG = triglycerides
individuals with diabetes mellitus.

y (-1); n (0)
y (-1); n (0)
Overall grade of evidence‡ low
†
‡
(high, moderate, low): if above score is (+), increase grade; if above score is (-), decrease grade from high to moderate (-1) or
low (-2).
Outcomes
To demonstrate the feasibility of monitoring glucose control among indigent women with
GDM over the Internet, women with GDM were randomized to either the Internet group (n=32)
or the control group (n=25).92 Patients in the Internet group were provided with computers and/or
Internet access if needed. A Web site was established for documentation of glucose values and
communication between the patient and the health care team. Women in the control group
maintained paper log books, which were reviewed at each prenatal visit. There was no difference
between the two groups in regards to either fasting or postprandial blood glucose values,
75
although more women in the Internet group received insulin therapy (31 percent vs. 4 percent;
P<0.05). There were also no significant differences in pregnancy and neonatal outcomes between
the two groups. 92
Another study compared physiological outcomes between an interactive diabetes Internet
program and the Diabetes Education Centers with respect to followup care for on-going diabetes
management. Participants were followed for 1 year and were assessed at baseline, 3 months, 6
months, and 1 year. Triglyceride levels improved significantly in the intervention group from
baseline to followup. Hemoglobin A1c levels were also significantly improved in the
intervention group at 3 months, but this improvement was not sustained to the 6-month or 1-year
time points.
Wise et al94 evaluated the impact of an interactive computer program on process and clinical
outcomes among insulin-dependent and noninsulin-dependent patients with diabetes. At 4-6
months, this application significantly improved HBA1c among both insulin dependent and non-
insulin dependent (Appendix G, Evidence Table 37).
Diet, Exercise, Physical Activity, not Obesity

Five studies addressed the impact of CHI applications on clinical outcomes related to diet,
exercise, or physical activity, not obesity. Clinical outcomes of interest were weight loss, change
in body weight, and change in body fat (Table 23). All of the studies were RCTs and four of the
five had low study quality (Appendix G, Evidence Table 1). One study by Tate et al44 received a
Jadad score of high due to the fact that it was blinded. Overall the studies showed results
indicating either no impact or a positive impact on one of the outcomes.

The volume of this literature is small, including only five studies addressing clinical
outcomes in CHI applications focused on in diet, exercise, physical activity, not obesity. Four of
the studies has small sample sizes of under 80 participants17,81,83,85 On study had a large number
of study participants; over 200.44 Followup periods ranged from 6 to 24 months. Blinding, as
measured by the Jadad criteria,4 was reported in one44 study but not in the remaining 4 of the
other studies (Appendix G, Evidence Table 1). The overall strength of the body of this evidence
(Table 24) was graded as low based on a modified version of the GRADE criteria5 and Chapter
11 of the EPC Manual.6
Outcomes
To assess computer-tailored feedback, 192 adults with a mean age of 49.2 years (SD 9.8) and
a mean BMI of 32.7 (SD 3.5) were randomized to one of three Internet treatment groups: no
counseling, computer-automated feedback, or human email counseling. All participants received
one weight loss group session, coupons for meal replacements, and access to an interactive Web
site. The human email counseling and computer-automated feedback groups also had access to
an electronic diary and message board. The human email counseling group received weekly
76
Table 23. Results of studies on CHI applications impacting clinical outcomes in diet, exercise,
physical activity, not obesity (N=5).

Diet/exercise/ 5 Adachi, Computer Percent weight loss +
†17
physical 2007 tailored program
activity with 6-mos
weight and
targeted
behavior’s self-
monitoring,
(Group KM)
Computer
tailored program
only,
(Group K)
Hunter, BIT Body weight (kg) +
200885
McConnon, Internet group Loss of 5% or more body weight (12 0
81
2007 months)
Tate, 200644 Tailored Weight loss +
Computer-
Automated
Feedback
Human Email
Counseling
Williamson, Interactive Body weight ‡(kg) 0
83
2006 Nutrition Body fat ║(%) +
education
program and
Internet
counseling
behavioral
therapy for the
intervention
group
†
the greatest effect of the intervention was seen at the 1-month post intervention time interval
‡
both parents and children showed a decrease in bodyweight at 6months, at the end of the followup period of 2 years all weight
lost was regained and there was no difference between intervention and control.
║
positive impact of reduction of body fat was greater in children and was only reported for the first 6 months post-intervention
BIT= behavioral Internet treatment; BMI= body mass index: ; kg = kilogram
77
Table 24. Grade of the body of evidence addressing CHI impact on clinical outcomes related to
diet, exercise, or physical activity, not obesity.

y (-1); n (0)
y (-1); n (0)
†
‡
low (-2).
e-mail feedback from a counselor, and the computer-automated feedback group received
automated, tailored messages. At 3 months, weight loss was greater for completers in both the
computer-automated feedback group (mean 5.3 kg, SD 4.2 kg) and human email counseling
group (mean 6.1 kg, SD 3.9 kg) compared with the no-counseling group (mean 2.8 kg, SD 3.5
kg), and the two intervention groups did not differ from each other. At 6 months, weight loss was
significantly greater in the human email counseling group (mean 7.3 kg, SD 6.2 kg) than in the
computer-automated feedback group (mean 4.9 kg, SD 5.9 kg) or no-counseling group (mean
2.6, SD 5.7 kg). Intent-to-treat analyses using single or multiple imputation techniques showed
the same pattern of significance. Providing automated computer-tailored feedback in an Internet
weight loss program was as effective as human email counseling at 3 months. 44
Another study examined the long-term effects of a new behavioral weight control program
(Kenkou-tatsujins, KT program) consisting of interactive communications twice in a month
communications including computer-tailored personal advice on treatment needs and behavioral
modification. Two hundred and five overweight Japanese women were recruited in an RCT
comparing Group KM (KT program with 6-month weight and targeted behavior self-
monitoring), Group K (KT program only), Group BM (an untailored self-help booklet with 7-
month self-monitoring of weight and walking), and Group B (the self-help booklet only).
Significant weight loss was observed in all groups. At 1 month, weight loss was greatest for
Groups KM and K, but at 7 months, the mean weight loss was significantly more in Group KM
than the other three groups. 17
To evaluate the efficacy of an Internet-based program for weight loss and weight-gain
prevention, 446 overweight individuals (222 men; 224 women) with a mean age of 34 years and
a mean BMI of 29 were recruited from a military medical research center with a population of
17,000 active-duty military personnel. Participants were randomly assigned to receive a 6-month
behavioral Internet treatment (BIT, n=227) or usual care (n=224). After 6 months, completers
who received BIT lost a mean of 1.3 kg while those assigned to usual care gained a mean of 0.6
kg (<0.001). 85
78
To determine the effectiveness of an Internet-based resource for obesity management, an
RCT was conducted in a community setting, where obese volunteers were randomly assigned to
an Internet group (n = 111) or usual care group (n =110). Data were collected at baseline, 6
months, and 12 months. Based on analysis conducted on all available data, the Internet group lost
a mean of 1.3 kg, compared with a 1.9 kg weight loss in the usual care group at 12 months, a
nonsignificant difference (difference = 0.6 kg; 95 percent CI: -1.4 to 2.5, p = 0.56). This trial
failed to show any additional benefit of this Web site in terms of weight loss compared with
usual care. 81
To test the efficacy of an Internet-based lifestyle behavior modification program for African
American girls over a 2-year period of intervention, 57 overweight African American girls (mean
BMI percentile, 98.3; mean age, 13.2 years) were randomly assigned to an interactive behavioral
Internet program or an Internet health education program, the control condition. Overweight
parents were also participants in the study. Forty adolescent-parent dyads (70 percent) completed
the 2-year trial. In comparison with the control condition, adolescents in the behavioral program
lost more mean body fat (BF) (-1.12 percent, SD 0.47 percent vs. 0.43 percent, SD 0.47 percent ,
p < 0.05), and parents in the behavioral program lost significantly more mean body weight (-2.43
kg, SD 0.66 kg vs. -0.35 kg, SD 0.64 kg, p<0.05) during the first 6 months. This weight loss was
regained over the next 18 months. After 2 years, differences in BF for adolescents (mean -0.08
percent, SD 0.71 percent vs. mean 0.84 percent, SD 0.72 percent) and weight for parents (mean
-1.1 kg, SD 0.91 vs. mean -0.60 kg, SD 0.89 kg) did not differ between the behavioral and
control programs. An Internet-based weight management program for African American
adolescent girls and their parents resulted in weight loss during the first 6 months but did not
yield long-term loss due to reduced use of the Web site over time 83(Table 23, and Appendix G,
Evidence Table 37).
Mental Health
Seven studies addressed the impact of CHI applications on mental health clinical outcomes
(Table 25). Outcomes of interest include depression, anxiety, and serological measures. All of
these studies were RCTs and received low scores according to the Jadad criteria (Appendix G,
Evidence table 1). All of the studies indicated a positive impact of the CHI application on at least
one of the reported outcomes. One study by Orbach et al133 showed a positive impact on anxiety
but no impact on the Hem reasoning test or general self efficacy.

The volume of this evidence is small, including only seven studies. Sample sizes in these
studies ranged from very small (<20) in March et al134to greater than 100 participants in
Chrstensen et al99, Ker et al135 and Hasson et al100 Followup periods were not reported in all
seven studies, but where they were reported, they ranged from 6 weeks99 up to 12 months.135
Blinding, as measured by the Jadad criteria,4 was not reported in any of the studies (Appendix G,
Evidence Table 1). The overall strength of the body of this evidence (Table 26) was graded as
low based on a modified version of the GRADE criteria5 and Chapter 11 of the EPC Manual6
79
Table 25. Results of studies on CHI applications impacting clinical outcomes in mental health
(N=7).

Mental 7 Christensen, Blue Pages: Center for Epidemiologic depression +
Health 2004†99 Computer scale
based psycho
education Web
site offering
information
about
depression
MoodGYM:
Computer
based Cognitive
Behavior
therapy
Hasson, Web-based DHE-S +
100
2005 stress NPY +
management CgA +
system TNFα +
Kerr, PACEi CESD score +
135
2008
March, Web based Reduction in childhood anxiety +
2008134 intervention
Orbach, Cognitive Test Anxiety Inventory +
133
2007 Behavior Anxiety Hierarchy Questionnaire +
Therapy group Heim Reasoning Test 0
(CBT) General Self-Efficacy Scale 0
Proudfoot, beating the BDI +
137
2003 blues BAI +
Work and social adjustment scale +
Spek, Group CBT Treatment response after 1 yr +
2008136
Internet based
intervention
†
positive impact was seen in both intervention groups, but was significant only in the MoodGym group
BDI= Beck depression inventory; BAI= Beck anxiety inventory; CBT = Cognitive behavioral therapy; CESD= Center for
Epidemiological Studies Depression ; CgA=chromogranin A; DHE-S=dehydroeoiandosterone sulphate; NPY=nueropeptide Y;
PACEi= Patient-centered Assessment and Counseling for exercise and nutrition via the Internet; TNFα= tumor necrosis factor
α
80
Table 26. Grade of the body of evidence addressing CHI impact on clinical outcomes in mental
health.

y (-1); n (0)
y (-1); n (0)
†
‡
low (-2).
Outcomes
A total of 191 women and 110 men (mean age 55 years, SD 4.6) with sub-threshold
depression were randomized into Internet-based treatment, group CBT (Lewinsohn’s Coping
with Depression Course) or a waiting-list control condition.136 The main outcome measure was
treatment response after 1 year, defined as the difference in pretreatment and followup scores on
the BDI. Simple contrasts showed a significant difference between the waiting-list condition and
Internet-based treatment (p=0.03) and no difference between both treatment conditions
(p=0.08).136
Another study assessed depressive symptoms in 401 participants in an RCT of a 12-month
primary care, phone, and Internet-based behavioral intervention for overweight women. A one-
way analysis of variance examining the mean change in Center for Epidemiological Studies
Depression (CESD) score from baseline to 12 months, controlling for age, education, marital
status, and employment, showed that those receiving the intervention significantly decreased
their CESD scores (p<0.03) more than those receiving standard care.135
To evaluate the efficacy of an Internet-based cognitive-behavioral therapy (CBT) approach to
the treatment of child anxiety disorders, 73 children with anxiety disorders, aged 7 to 12 years,
and their parents were randomly assigned to either an Internet-based CBT (NET) or wait-list
(WL) condition. The NET condition was reassessed at 6-month followup. At posttreatment
assessment, children in the NET condition showed small but significantly greater reductions in
anxiety symptoms and increases in functioning than WL participants. These improvements were
enhanced during the 6-month followup period, with 75 percent of NET children free of their
primary diagnosis. The conclusion was that Internet delivery of CBT for child anxiety offered
promise as a way of increasing access to treatment for this population.134
To assess possible effects on mental and physical well-being and stress-related biological
markers of a Web-based health promotion tool, 303 employees (187 men and 116 women, age
23–64 years) from four information technology and two media companies were enrolled. Half of
81
the participants were offered Web-based health promotion and stress management training
(intervention) lasting for 6 months. All other participants constituted the reference group.
Clinical outcomes consisted of different biological markers measured to detect possible
physiological changes. After 6 months, the intervention group had improved statistically
significantly compared to the reference group on ratings of ability to manage stress, sleep
quality, mental energy, concentration ability, and social support. The anabolic hormone
dehydroepiandosterone sulphate (DHEA-S) decreased significantly in the reference group as
compared to unchanged levels in the intervention group. Neuropeptide Y (NPY) increased
significantly in the intervention group compared to the reference group. Chromogranin A (CgA)
decreased significantly in the intervention group as compared to the reference group. Tumour
necrosis factor α (TNFα) decreased significantly in the reference group compared to the
intervention group.100
To test the hypothesis that CBT, available on the Internet, could reduce test anxiety, 90
university students were randomly allocated to CBT or a control program, both on the Internet.
Before and after treatment, the participants completed the Test Anxiety Inventory (TAI), an
Anxiety Hierarchy Questionnaire (AHQ), the Exam Problem-Solving Inventory (EPSI), the
General Self-Efficacy Scale (GSES) and the Heim reasoning tests (AH) as a measure of test
performance. Of the CBT and control groups 28 percent and 35 percent, respectively, withdrew.
According to the TAI, 53 percent of the CBT group showed a reliable and clinically significant
improvement with treatment but only 29 percent of the control group exhibited such a change.
On the AHQ, 67 percent of the CBT group and 36 percent of the control group showed a
clinically significant improvement, more than two standard deviations above the mean of the
baseline, a change in favor of CBT. Both groups improved on the GSES, in state anxiety during
exams retrospectively assessed, and on the AHQ tests. The study supported use of CBT on the
Internet for the treatment of test anxiety. 133
A study by Christensen et al99 studied the impact of two different Internet interventions
(MoodGym and BluePages) on community-dwelling individuals with symptoms of depression.
To measure symptom change after the intervention, the 20-item CESD score was the primary
outcome measure. The mean change in score was greater in the Internet intervention groups than
in the control group. The difference was significant in the MoodGym group but not the
BluePages group.
To measure the impact of the “beating the Blues” (BtB) interactive multimedia CBT program
on anxiety and depression, Proudfoot et al 2003137 compared this program with usual treatment
(or treatment as usual) for depression and anxiety. Three measures were used: the BDI, the BAI,
and the Work and Social Adjustment (WSA) Scale. There was a significantly greater drop (of 5
points) in the BDI score in the BtB group compared to the usual care group. This drop was seen
at 1 month post-intervention and was maintained over the six month followup period.
Significance was not reported. A similar result was seen in the BAI score with a difference in
reduction in score between the BtB group and usual care of 3 points. This change was sustained
over the 6 month followup period. No significance was reported. Again, similar results were seen
in the WSA score with a difference in reduction in score between the BtB group and usual care
of 3 points. This change was sustained over the 6 month followup period. No significance was
reported (Table 24, and Appendix G, Evidence Table 37).
82
Miscellaneous Outcomes
Ten studies evaluated the impact of CHI applications on clinical outcomes in various other
health conditions (Table 27). Outcomes of interest included quality of life and disease-specific
clinical outcomes. These outcomes were examined in the context of the following health
problems: Alzheimer’s disease, arthritis, asthma, back pain, chronic adult aphasia, COPD,
headache, HIV/AIDS, general pain, and obesity. The quality of these 10 studies was moderate to
low.

The literature in this area had significant limitations. There were only a few studies for each
particular condition. The disease-specific clinical outcomes evaluated for the same condition in
different studies were not fully comparable. The same problem was true of the general quality of
life measures used across various conditions in different studies. This limited the possibility of
cross-study comparisons. The quality of these trials was variable with some studies lacking in
one or more methodological domains of RCT quality as measured by the Jadad4 criteria
(Appendix G, Evidence Tables 35-37). The majority of the studies did not fully comply with
CONSORT138guidelines or had low study quality scores. Several studies were based on a very
small sample size or relied on a short follow up period. Sample size varied from as little as 16 in
an entire study to 651. Postintervention evaluations ranged from as little as 6 weeks to as many
as 24 months. Although there was sparse data for each target condition within this category of
outcomes, we felt that grading the evidence was important due to the large number f studies. The
overall strength of the body of this evidence was not graded as it was too heterogeneous.
Outcomes
Alzheimer’s disease. This was a 24-week study of 46 mildly impaired patients suspected of
having Alzheimer’s disease receiving stable treatment with cholinesterase inhibitors (ChEIs).
The patients were divided into three groups: 1) those who received three weekly, 20-min
sessions of interactive multimedia Internet-based system (IMIS) in addition to eight hours per
day of an integrated psychostimulation program (IPP); 2) those who received only IPP sessions;
and 3) those who received only ChEI treatment. The primary outcome measure was the
Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog). Secondary outcome measures
were: Mini-Mental State Examination (MMSE), Syndrome Kurztest, Boston Naming Test,
Verbal Fluency, and the Rivermead Behavioral Memory Test story recall subtest. Although both
the IPP and IMIS improved cognition in patients with Alzheimer’s disease, the IMIS program
provided an improvement above and beyond that seen with IPP alone, which lasted for 24
weeks139(Appendix G, Evidence Table 37).
Arthritis. To determine the efficacy of an Internet-based Arthritis Self-Management
Program (ASMP), randomized intervention participants were compared with usual care controls
at 6 months and 1 year using repeated-measures analyses of variance. Patients with rheumatoid
83
Table 27. Studies of CHI applications impacting miscellaneous clinical outcomes (N=10).
Target Number of Author, year Interventions Primary outcomes measured

condition studies
Alzheimer’s 1 Tarraga, 2006139 IMIS,IPP, Alzheimer’s Disease Assessment
disease ChEIs Scale-Cognitive
IPP,ChEIs
Arthritis 1 Lorig, 2008114 Online intervention Health distress
Activity limitation
Self reported global health
Pain
Self efficacy
Asthma 1 Jan, 200710 Participants Symptom score at nighttime
received asthma Symptom score at daytime
education and with
interactive asthma Morning PEF
monitoring system Night PEF
Back Pain 1 Buhrman, 2004115 Cognitive Behavior CSQ-Catastrophizing
Intervention CSQ-Ability to decrease pain
CSQ-Control over pain
Chronic Adult 1 Katz, Computer reading Porch Index of Communicative
140
Aphasia 1997 treatment Ability (percentiles): Overall
Porch Index of Communicative
Computer stimulation Ability (percentiles): Verbal
Western Aphasia Battery Aphasia
"Quotient"
Western Aphasia Battery Aphasia
"Repetition"
COPD 1 Nguyen, 2008110 Electronic dyspnea self Score on CRQ subscale for
management program dyspnea with ADLs
Headache 1 Trautman, 2008141 CBT Frequency
Duration
Intensity
Pain catastrophizing
HIV/AIDS 1 Gustafson, CHESS Active life
1999142 Social support
Participation in health care
Obesity 1 Morgan, 200991 Tailored Web-site Change in body weight at 3 and 6
months
Change in waist circumference at
3 and 6 months
BMI at 3 and 6 months
Systolic blood pressure at 3 and 6
months
Diastolic blood pressure at 3 and
6 months
Resting heart rate at 3 and 6
months
Pain 1 Borckardt, 2007143 CACIS Cold Pressor Tolerance
IMIS=interactive multi-media Internet-based system; IPP= integrated psychostimulation program; ChEIs = cholinesterase
inhibitors; PEF= peak expiratory flow; CSQ= coping strategies questionnaire; CRQ= chronic respiratory questionnaire; ADL=
activities of daily living; FBS= fasting blood sugar; FBG= fasting blood glucose; TC = total cholesterol; TG= triglycerides; BIT=
behavioral Internet treatment; BMI= body mass index: CHESS= Comprehensive Health Enhancement Support System; CACIS
computer assisted cognitive imagery system
84
arthritis, osteoarthritis, or fibromyalgia and Internet and email access (n=855) were randomized
to an intervention (n=433) or usual care control (n=422) group. Measures included six clinical
outcomes: pain, fatigue, activity limitation, health distress, disability, and self-reported global
health. At 1 year, the intervention group significantly improved in four of six clinical outcomes
as compared to baseline: health distress (p<0.001), activity limitation (p < 0.001), self-reported
global health (p<0.004), and pain (p<0.001). The Internet-based ASMP proved effective in
improving clinical outcomes in arthritis patients114 (Appendix G, Evidence Table 37).
Asthma. To assess an Internet-based interactive asthma educational and monitoring program
used in the management of asthmatic children, 164 pediatric patients with persistent asthma were
enrolled and randomized into two study groups for a 12-week controlled trial. The intervention
group had 88 participants who were taught to monitor their peak expiratory flows (PEF) and
asthma symptoms daily on the Internet. Clinical outcomes were assessed by weekly averaged
peak expiratory flow (PEF) values, symptom scores, asthma control tests, and quality of life. At
the end of trial, the intervention group decreased the nighttime symptom score (range: 0=no
asthma symptoms, 1=symptoms occurred several times but do not interfere with daily activities,
2=symptoms interfere with daily activities, 3= symptoms interfere with all activities), (mean
change -0.08, SD 0.33 vs. 0.00, SD 0.20, p<0.028) and daytime symptom score (mean change -
0.07, SD 0.33 vs. 0.01, SD 0.18, p<0.009); improved morning PEF (mean change 241.9 L/min,
SD 81.4 vs. 223.1L/min, SD 55.5, p<0.017) and night PEF (mean change 255.6 L/min, SD 86.7
vs. 232.5 L/min, SD 55.3, p<0.010); improved the rate of having well-controlled asthma (70.4
percent vs. 55.3 percent, p<0.05); and improved quality of life on a 7-point scale (mean 6.5, SD
0.5 vs. 4.3, SD 1.2, p<0.05) when compared with conventional management. The Internet-based
asthma telemonitoring program improved clinical outcomes in pediatric asthma patients10
Back pain. To investigate the effects of an Internet-based CBI with telephone support for
chronic back pain, 56 subjects with chronic back pain were randomly assigned to either an
Internet-based cognitive-behavioral self-help treatment or to a waiting-list control condition. The
study period lasted 8 weeks and consisted of 1 week of self-monitoring prior to the intervention,
6 weeks of intervention, and 1 week of postintervention assessment. Treatment consisted of
education, cognitive skill acquisition, behavioral rehearsal, generalization, and maintenance. The
study showed statistically significant improvements in catastrophizing, control over pain, and
ability to decrease pain. The findings indicated that Internet-based self-help with telephone
support, based on established psychological treatment methods, holds promise as an effective
approach for treating disability in association with pain 115 (Appendix G, Evidence Table 37).
Chronic adult aphasia. To examine the effects of computer-provided reading activities on
language performance in chronic aphasic patients, 55 aphasic adults were assigned randomly to
one of three conditions: computer reading treatment, computer stimulation, or no treatment.
Subjects in the computer groups used a computer 3 hours each week for 26 weeks. Computer
reading treatment software consisted of visual matching and reading comprehension tasks.
Computer simulation software consisted of nonverbal games and cognitive rehabilitation tasks.
Language measures were administered to all subjects at entry and after 3 and 6 months.
Significant improvement over the 26 weeks occurred on five language measures for the
computer reading treatment group, on one language measure for the computer stimulation group,
and on none of the language measures for the no-treatment group. The computer reading
treatment group displayed significantly more improvement on the Porch Index of
Communicative Ability "Overall" and "Verbal" modality percentiles and on the Western Aphasia
85
Battery "Quotient" and "Repetition" subtest than the other two groups140 (Appendix G, Evidence
Table 37).
COPD. One study tested the efficacy of two 6-month dyspnea self-management programs,
Internet-based (eDSMP) and face-to-face (fDSMP), on dyspnea with activities of daily living
(ADL) in people living with COPD. Fifty participants with moderate to severe COPD who were
current Internet users were randomized to either the eDSMP (n = 26) or fDSMP (n = 24) group.
The content of the two programs was similar, focusing on education, skills training, and ongoing
support for dyspnea self-management, including independent exercise. The only difference was
the mode (Internet/personal digital assistant [PDA] or face-to-face) in which the education
sessions, reinforcement contacts, and peer interactions took place. The primary clinical outcome
was dyspnea with ADL that was measured with the Chronic Respiratory Questionnaire. The
study was stopped early due to multiple technical challenges with the eDSMP, but followup was
completed on all enrolled participants. Analysis of data available from the remaining 39
participants did not show significant differences between intervention and control groups110
Headache. Sixteen participants participated in a study to compare the efficacy of an on-line
cognitive behavioral treatment (CBT) program with an Internet-based psychoeducational 141
intervention using chat groups (control) on pediatric headache. The main outcome measures
were frequency, duration, intensity, and pain catastrophization. There were no significant
differences in changes between the groups for all of the outcome measures. However, the
frequency of headaches in the CBT group postintervention decreased. Headache duration and
intensity did not change significantly for the CBT group. Pain catastrophizing was reduced
significantly post treatment. At the 6-month followup, the treatment effects had not diminished
HIV/AIDS. To test a computerized system (CHESS: Comprehensive Health Enhancement
Support System), which provided HIV-positive patients with information, decision support, and
connections to experts and other patients, 204 HIV-positive patients (90 percent male, 84 percent
White, most having at least some college education, and 65 percent experiencing HIV-related
symptoms) were randomized to an intervention group (CHESS computers in experimental
subjects’ homes for 3 or 6 months) or control group (no intervention). The following quality of
life sub-scores were significantly different between control and intervention groups in 6-month
followup: active life (1.37 vs. 1.66, p<0.034), social support (4.24 vs. 4.47, p<0.017), and
participation in health care (3.64 vs. 4.15, p<0.020)142 (Appendix G, Evidence Table 37).
Pain. This study was designed to compare the effectiveness of a computerized pain
management program over a distraction control. A computer-assisted cognitive/imagery system
(CACIS) was used to assist subjects in pain management.143 The control group used an identical
system as the intervention group; the difference between the two being the control group group
received a prerecorded story about migratory bird patterns with no animation in the visual
presentation. The intervention group heard a male voice framing the experience as unpleasant
instead of painful. An individual’s pain was animated on the screen. Each group was subjected to
an ice water bath for up to 150 seconds, depending on pain tolerance. The intervention group was
able to tolerate the cold for 13 seconds longer than the control group, but this was not a
significant difference (Appendix G, Evidence Table 37).
86
Key Question 1e. What evidence exists that consumer health
informatics applications impact economic outcomes?
Three studies evaluated the impact of CHI applications on economic outcomes (Table 28).
These outcomes were examined in the context of 3 health problems including asthma, cancer
(breast, cervical prostate and laryngeal), and obesity. Studies were very heterogeneous in respect
to their target areas of interest and outcomes. They will be discussed individually below.
Table 28. Studies of CHI applications impacting economic outcomes (N=3).
Target Number of Author, year Interventions Primary outcomes measured

condition studies
Asthma 1 Joseph, 200715 Treatment Cost of program delivery to
developers
Cancer, breast, 1 Jones, 1999109 General computer Cost of the computer information
cervical information system—Manual extraction of
prostate, and Patient data
laryngeal Tailored computer Cost of the computer information
information system—use of electronic
patient record
Materials cost
Obesity 1 McConnon, Web site (Internet Total costs to user
200781 group) Incremental cost-effectiveness

Three studies evaluated six domains of CHI impact on economic outcomes. All of the studies
addressing economic outcomes had relatively large sample sizes: greater than 300 for the study
on asthma,109 152 in the control arm,162 in the intervention arm; greater than 450 in the study on
cancer,15 162 in the control arm, 143 in the general information arm, and 162 in the tailored
intervention; and more than 100 participants in the study on obesity81 (Appendix G, Evidence
Tables 38-40). The quality of these 3 trials was low to moderately low with studies lacking in
one or more methodological domains of RCT quality as measured by the Jadad criteria 4
(Appendix G, Evidence Table 1). The body of evidence was not graded for this sub-question due
to the small number of studies.

The studies that were evaluations of the impact of CHI applications on economic outcomes
generally were tested on an adult population (mean age: 47.4-48.1 years) in the study addressing
obesity,81 on a juvenile population in the study on asthma (mean age 15.3 years),109 and not
specified in the study on cancer.15 Information regarding gender was only reported in the paper
on asthma where 63 percent of the population was female.109 None of the studies reported on the
race/ethnicity, or socioeconomic status (SES) of study participants. The asthma study109 reported
on smoking status of greater than or equal to 2 cigarettes per day in 5.2 percent of the population,
87
and the obesity study81 reported on weight, BMI, quality of life, and physical activity in each of
the study groups (Appendix G, Evidence Tables 38 and 39).
Outcomes
Asthma. The economic measure in the study on asthma was identified as the “cost of
program delivery.” At the end of the study period (12 months), the cost of the referral
coordinator (the only measurable cost of the study) was $6.66 per treatment per student. There
was no cost estimate for the control group 109 (Appendix G. Evidence Table 40).
Cancer: breast, cervical, prostate, and laryngeal. There were three measures of cost in the
study on cancer. The first measure was the actual cost of implementing the computer information
system using manual entry of patient data. The authors found that the cost to manually extract
patient data into a computer information system would cost 9 times as much as the control or a
general information site. The next measure identified the cost of importing the electronic patient
record into the tailored information system. There was no difference found in cost between the
general information system and the tailored system using this method. The final measure of cost
studied was material cost. The control group used paper (books) and the cost per book was
estimated at £7. The cost of the general information system was estimated to be 40 percent of
this, or £2.8 per patient. No information was provided for per user cost of the tailored
information system15 (Appendix G. Evidence Table 40).
Obesity. The obesity study measured total costs and incremental cost effectiveness. The total
cost for the control group was £276.12 compared to the total cost for the Web site intervention
group of £992.40. The authors pointed out that the difference in cost was due to the cost of
developing the Web site. They stated that when this fixed cost was removed, the total costs of the
intervention were lower. However, the actual estimate was not reported. Incremental cost-
effectiveness was calculated for the intervention group, and was reported as £39,248 per quality-
adjusted life-year81 (Appendix G. Evidence Table 40).
Key Question 2: What are the barriers that clinicians,

developers, and consumers and their families or caregivers
encounter that limit implementation of consumer health
informatics applications?
Thirty-one studies were reviewed that addressed the barriers to CHI applications, with a
focus on studies that reported on CHI applications that were individualized to the consumers’ or
caregivers’ needs. Documented barriers to CHI applications were identified, extracted, and
tabulated.
Disease/Problem Domain
The CHI applications focused on a specific disease or problem domain. Two studies
addressed more than one disease (breast cancer – all cancers144; HIV/AIDS – STDs145), but the
remaining 20 studies focused on only one disease or problem domain. Diseases included breast
cancer (4), 144,146-148 mental health (3),149-151 physical activity/diet/obesity (4),36,152-154 diabetes
88
(3),93,155,156 HIV/AIDS (2),145,157 prostate cancer (1),158 all cancers (1),144 hypertension (1), 159
STDs (1).145 Problem domains included use of a personal health record (3)160-162 and review of
systems (1).163
For the purpose of further analysis, the study focusing on breast cancer and all cancers 144
was collapsed under “all cancers” (leaving three breast cancer related studies) and the study
dealing with HIV/AIDS and STDs145 under HIV/AIDS (leaving no study on STDs) (Appendix
G, Evidence Tables 41-43).
Methodology
The methodology used to identify barriers varied across studies (Tables 29 and 30). There
were four categories including validated survey, nonvalidated survey, qualitative research, and
empirical research. Five studies used more than one methodology. 36,145,150,153,160 If a study used
either a validated survey or empirical research, it was collapsed under “Validated survey /
Empirical.” Otherwise, it was assigned “Nonvalidated survey / Qualitative” as the research
methodology (Appendix G, Evidence Tables 41-43).
CHI applications require participation of consumers, their caregivers, clinicians, and
developers. Barriers can apply to any of the participants, and the type and impact of the barrier
may vary significantly between providers, developers, patients, and their caregivers. Thus, an
analysis of the barriers must include those that impede participation of any of the above groups.
89
Table 29. The distribution of methodologies for identifying barriers to the use of consumer health
informatics by disease /problem domain.
Methodology Non-validated survey / Validated survey /

Disease Qualitative Empirical Total
All Cancers 2 2
Breast Cancer 1 2 3
Diabetes 5 5
HIV/AIDS 3 3
Hypertension 1 1
Mental Health 3 3
Personal health record 2 1 3
Physical Activity / Diet /
Obesity 6 1 7
Prostate Cancer 1 1
Review of systems 1 1
Smoking Cessation 2 2
Total 24 7 31
Table 30. The distribution of methodology by barrier type.
Methodology Non-validated survey / Validated survey /

Barrier Qualitative Empirical Total
Systems & User Level 6 1 7
Systems level 3 2 5
User level 15 4 19
Total 24 7 31
Barriers
Barriers were divided between system-level and the individual-level barriers (Table 31):
1. System-level barriers were further divided into technical or health care system issues.
Technical barriers included usability, work flow issues, and data security concerns.
Health care system issues included the reimbursement system and incompatibility
between patient applications and legacy systems in health care institutions.
2. Individual level barriers pertained to either the clinician or the consumer. Clinician
endorsement affects consumer choice, and thus negative attitudes of clinicians may be a
barrier to consumer use. Consumer issues included lack of access to the application (e.g.,
no home Internet access), concerns about privacy, limited literacy and knowledge,
language hurdles, cultural issues, and lack of technologic skills (Appendix G, Evidence
Tables 41-43).
90
Table 31. The distribution of barrier levels by disease/problem domain.
Barrier Both levels Systems level User level Total

Disease/Problem
Domain
All Cancers 1 1 2
Breast Cancer 3 3
Diabetes 2 3 5
HIV/AIDS 1 2 3
Hypertension 1 1
Mental Health 1 1 1 3
Personal health record 2 1 3
Physical Activity/ Diet / Obesity 3 4 7
Prostate Cancer 1 1
Review of systems 1 1
Smoking Cessation 2 2
Total 7 5 19 31
System-level barriers.
Technical system-level barriers. Nine studies explored lack of Internet access at home or in
the community and six found this to be a barrier147,152,153,156,159,160 (Appendix G, Evidence Table
43). One study identified hardware requirements as a systems level barrier.164 and another study
identified mobile device shape/design/configuration as a systems level barrier.165
Health care system-level barriers. Five studies cited incompatibility with current care as a
barrier145,157,159,160,163 (Appendix G, Evidence Table 43).
Individual-level barriers.
Clinicians. One study noted that the clinic staff feared more work. 151 Of note, the
applications that were included in the literature review were applications that are operated
independently by consumers, so there are no applications that require the physician to interact
directly with the consumer through a CHI application (Appendix G, Evidence Table 43).
Developers. One study cited lack of built-in social support in the CHI application as a barrier.
93
One study noted that patients forgot their passwords by the time they had their followup visit.
151
One study cited lack of training and guidance in the use of the application. 160 Along the same
lines, one study reported that electronic tools for data entry were a problem for users 144, whereas
another cited the lack of automated data entry as a problem. 155 In one study users complained
about a design that did not allow for back entry of old data.165 Two studies discussed lack of user
customization or making the content more relevant to the consumer and his or her community as
a barrier93,154 (Appendix G, Evidence Table 43). Two studies focused on the “substantial
investment” required for the development and maintenance of CHI resources.75,166
Consumers and their caregivers. Nineteen studies queried application usability or user-
friendliness and all nineteen found evidence of this barrier36,147-149,151-158,160,161,163,167-169(Appendix
G, Evidence Table 43).
Eleven studies explored patient knowledge, literacy, and skills to use the CHI application.
Deficits in these areas were found by one study not to be a barrier. 146 The other ten, plus one
study that had not initially considered these barriers in the study design, did find these deficits to
be barriers 144,148,150,151,156,157,159-163 (Appendix G, Evidence Table 43).
Six studies considered the possibility that users would find the application too time-
consuming and five of these reported this barrier in the results section. 152 In the same vein, one
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study cited too many emails to participants as a barrier.169One study queried consumers about the
acceptability of fees for use of an interactive portal and found that most participants were not
willing to pay any fee for the service.166
Five studies sought information about privacy concerns and four reported concerns over
privacy as a barrier in their finding.144,145,151,161 The same four studies queried and found
concerns over the control of information or lack of trust to be barriers144,145,151,161(Appendix G,
Evidence Table 43).
Two studies queried for cultural barriers and only one study found evidence of this. 146
One study found the language of the CHI application to be a barrier. 161
The expectations of consumers figured prominently in the barriers analysis. The terms
acceptability, usefulness, credibility, expectations, and goals were mentioned often and the lack
thereof was found to indicate barriers in eight studies 20,93,165,167 36,147,151,157(Appendix G,
Evidence Table 43).
One study of an interactive Web portal did not identify a barrier regarding usefulness, but
found that most participants who had not used the portal expected a number of features to be
useful, but less users of the portal actually rated these features as useful.166
Cost was mentioned as a barrier in only one study.165
Three studies investigated consumer disability, generally grouped as physical or cognitive.
One did find evidence that physical or cognitive impairment resulted in barriers to the use of CHI
applications. 162 One found that not reacting to visual preferences was a barrier. 158
Anxiety over the use of computers, complaints about lack of personal contact with clinicians and
the belief that IT would not be an improvement to current care were mentioned in two studies as
barriers159,162 (Appendix G, Evidence Table 43).
Key Question 3: What knowledge or evidence deficits exist

regarding needed information to support estimates of cost,
benefit, and net value with regard to consumer health
informatics applications?
Upon review of the results of the systematic review presented above, several important
knowledge gaps became evident. In general, the literature was at a very early stage of
development. Many questions have only been evaluated by one study. Thus, confirmatory
studies have generally not been done. In addition, no high quality studies have been conducted
regarding several important questions. Broadly, these questions can be grouped into at least one
of the following four categories: patient-related questions, CHI utilization factors,
technology/hardware/software/platform-related issues, and health-related questions. The major
questions and outstanding issues of concern for each of these sections will be outlined below.
Patient-related Questions
Many questions about CHI applications at the patient level remain. The results of our review
suggested that the literature is relatively silent on the question of whether or not significant
differences in patient preferences, knowledge, attitudes, beliefs, needs, utilization, and potential
benefits exists across gender, age, and race/ethnicity. Intuitively, we suspect some differences
exist, especially as they relate to the senior population compared to the adolescent population.
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However, these differences have not been definitively characterized, and the clinical and public
health implications of these differences are largely unknown. The same could be said for
potential gender- and race or ethnicity-based differences. Early evidence suggests that potentially
significant differences exist that could have important health implications as we move toward a
more technology-saturated society.170,171 Beyond these potential demographic differences, the
emerging field of CHI is developing within the context of a societal and even global emergence
of technology-based realities, including Web 2.0/Web 3.0 and ubiquitous computing, which are
enabling an unprecedented level of user-determined interactivity and functionality. The degree
to which this functionality could be harnessed for the health benefit of consumers is largely
unknown. Along these lines, with the predominance of chronic diseases and the burgeoning of
the senior population in this country, there is an increasing reliance on nonprofessional family,
community, and low-skilled caregivers providing ever increasing levels of care to patients. As
such, the target users of CHI applications must increasingly be focused on more than just the
index patient. Our review suggested that the majority (but not all) of the current RCT CHI
literature is focused on the patient as the CHI user. Finally, given the increasing role of family
members, friends, and other caregivers, sociocultural and community factors will likely exert
significant impact on access, usability, desirability, and benefit of CHI applications. Issues
related to trust, security, and confidentiality need to be further explored.
CHI Utilization-related Factors

Given the ubiquity of the Internet, the overwhelming majority of current and developing CHI
applications will likely be reliant at least in part on the Internet. Increasingly this will require that
consumers have broadband access to the Internet to take advantage of the full functionality that
CHI applications potentially have to offer. Despite a rapid increase in both the availability and
access to broadband services among all population groups, age groups, and geographic regions
of the country (eHealth Solutions for Health Care Disparities Gibbons (ed) 2007 Springer Pub),
differential access to broadband Internet access may have significant implications in terms of
health benefits that may be derived from these tools and applications. Of equal concern, while
many in the younger generations become very technically savvy at an early age, many
Americans still have limited health literacy (eHealth Solutions for Health Care Disparities
Gibbons (ed) 2007 Springer Pub). The combination of low technology expertise and low health
literacy may pose insurmountable barriers for some individuals. The ability of these individuals
to use and benefit from CHI applications, even when adequate access exists, should be evaluated.
Taken together then, these CHI utilization factors suggest the need for a more robust evaluation
and explication of the epidemiology of broadband access and technology literacy in the US.
Technology/Hardware/Software/Platform-Related Issues
The results of our review suggest that the majority of currently evaluated CHI tools and
applications are designed for use on personal computers (desktop, laptop) as Web-based
applications. While these technology platforms have certainly not been exhaustively studied,
many more potential platforms exist, including interactive webTV, Video On Demand,
smartphones, and health gaming to name a few. In the domestic literature, the potential of these
platforms has not been evaluated. In addition, it appears that the CHI applications evaluated to
date have been designed primarily by health care practitioners without sufficient training or
93
expertise in critical design areas such as human factors and user-centered design. As such,
currently available tools may not be the best possible tools and may yield disappointing results
despite well-designed evaluation studies. Emerging evidence from the Robert Wood Johnson
Foundation’s Project HealthDesign and other similar projects is suggesting that the CHI tools
and applications and functionality that consumers want and need are not always what health care
practitioners think they need.172 Furthermore, many health care practitioners and entrepreneurs
are likely ill-equipped to integrate the appropriate data, as suggested above, into the design
process. As a result, important sociocultural and human computer interface design elements may
not get incorporated adequately into emerging CHI applications and therefore may lead to CHI
applications with limited efficacy.
Health-related Factors
Finally, the results of our review suggested that several important health-related questions
remain regarding the potential utility of CHI applications. To date, most CHI applications that
have been evaluated tend to focus on one or more domains of chronic disease management.
While this is very important and clearly needed, insufficient attention has been given to the role
of CHI applications in the acute exacerbation of symptomatology or other urgent and emergent
problems that may occur in home- and community-based settings. While it remains clear that
professional expertise is increasingly needed as the acuity of the problem increases, with the
growing dominance of home- and community-based care and self-management, telephone and/or
ambulance transfer to an emergency room may not represent the most efficient and cost effective
way to access professional health care personnel and services. Along these lines, the role of CHI
applications in primary, secondary, and tertiary prevention needs to be more adequately
explored. Given the prevalence of mental health and psychiatric issues, the value of CHI
applications in the context of mental health, coping, and stress should be evaluated. Finally
sociocultural factors are increasingly important determinants of health care outcomes. The
potential impact on social factors including social isolation and social support and perhaps even
broader social determinants of health need to be evaluated and may prove useful in helping
patients address select health concerns in the home- and community-based setting.
Key Question 4: What critical information regarding the

impact of consumer health informatics applications is
needed in order to give consumers, their families, clinicians,
and developers a clear understanding of the value
proposition particular to them?
The results of the current review suggest that several critical information needs still exist that
must be filled to enable a clear understanding of the value proposition of CHI applications. It is
likely that the knowledge gaps needed to establish a value proposition, while overlapping, are not
identical across all potential stakeholders. We will address this question from 2 perspectives, that
of the clinician or provider and that of the patient, family and caregiver.
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Clinician and Provider Value Proposition Information Needs
While this review focused on CHI applications that are not dependent on a clinical provider,
they at times may involve providers. It is well known that provider recommendations and
support can be an important motivator for some patients to engage in a certain behavior. It may
be that provider recognition and support of patient use of CHI could play an important role in the
adoption and use of CHI applications by some patients. Because providers are often most
concerned about clinical outcomes and costs, it seems reasonable that questions of the impact of
CHI applications on provider or health care processes, costs, and outcomes as addressed in this
report will need to be more definitively characterized. There is at least one additional critical
knowledge need that is pertinent to providers. It is the potential liability a provider might incur
from a patient using a CHI application. It is not clear at this point that any liability would exist
under current law, particularly for those CHI applications that do not involve a health care
professional. Yet it may be that this question will need some further clarification prior to
widespread endorsement of CHI applications by many health care providers.
Patient, Family, and Caregiver Value Proposition Information Needs

While it is tempting to believe that patients want the exact same thing as their providers and
health care practitioners, we know that this is not always the case. Indeed the growth of the
Internet and its utilization first by consumers and then providers can be very instructive
regarding value proposition needs of consumers.173 This data and experience suggest that
patients and caregivers are, except in the cast of an emergent problem, often most concerned
with well-being issues, health care processes, costs, and then clinical outcomes. Patients most
often cite convenience and anonymity as the primary reasons the Internet has become such a
major source of health information.173 Interestingly, both of these characteristics are largely
lacking from our health care system today. It is likely that the more these elements can be
incorporated into emerging CHI applications, the more likely they will be considered of value by
consumers. Other related factors such as usability, portability, and patient-centered functionality
are likely important characteristics of CHI applications that may help drive utilization. It has
been suggested that the degree to which technology becomes “invisible,” or becomes
incorporated into an individual’s lifestyle rather than creating additional tasks or processes, is the
degree to which these tools will become more powerful. Those technologies that exist and enable
consumers to accomplish tasks (empower) without further complicating individuals lives may
ultimately prove to be the most widely used and valued CHI applications. Finally, by expanding
the list of available platforms from which consumers can utilize CHI tools and applications (TV,
WebTV, satellite, On Demand, health gaming), CHI applications may become more appealing to
a broader consumer base and thus prove valuable to those consumers who could most benefit,
but may not otherwise use a more traditional CHI application.
Research in Progress
Based on a search string developed early in the development of the project (see Appendix C),
a similar search string was developed to search the grey literature for ongoing research (Health
Services Research Projects in Progress database). Our search identified 180 titles that were
reviewed for relevance to our study topic. Four ongoing and continuing research studies were
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identified. The outcomes in these studies may provide additional information about the success
of a consumer-centered approach to health care. All these studies were designed to develop
Internet-based health informatics that in the end will be helpful in improving the quality of care
and creating a more informed consumer. The results of these studies have not been published yet.
One study by Christakis,171 is an ongoing study to develop an Internet-based patient-centered
asthma management system. A critical feature of the study is to improve the quality of asthma
care delivery by health care providers. The study will gauge the effectiveness of AsthmaNet, a
Web-based asthma patient activation system, which will provide tailored clinical information to
parents as well as give them decision aids to share with their providers.
In another study, which was completed in 2008, Lorig et al174 evaluated the usefulness of
translating evidenced-based small-group diabetes education on to an Internet platform. The main
aims of the 2-year RCT were to: 1) develop, implement, and evaluate an Internet Diabetes Self-
Management Program (IDSMP) compared with usual care; 2) compare the effects of the IDSMP
with and without email discussion group reinforcement; 3) conduct cost-benefit analysis of the
IDSMP compared with usual care, and the IDSMP with and without reinforcement; and 4)
conduct a process evaluation of the use of the sections of the IDSMP and how usage, changes in
behaviors, changes in self-efficacy, and patient characteristics are associated with intervention
effects (health status and health care utilization) at 6 months and 2 years.
Another completed study completed in 2005, by Col175 was designed to address the issues
involved with menopause. The immediate goal was to develop a technology comprehensive
Menopause Interactive Decision Aid System (MIDAS) that provides personalized feedback
about menopausal symptoms, risks for common conditions, and the effects of different treatment
options on the short- and long-term consequences of menopause. The main hypotheses of this
study are that MIDAS can: 1) lead to better decisions and improve the quality of menopausal
counseling; 2) improve compliance with a chosen menopausal plan; and 3) reduce medical errors
associated with the use of menopausal therapies. The specific aims are to: 1) develop and
optimize the utilization of MIDAS; 2) evaluate the impact of MIDAS on the decisionmaking
process, including decisional conflict, knowledge, risk perception, anxiety, patient-physician
communication, satisfaction with decisionmaking, the quality of menopause counseling, and
medical errors related to menopausal therapy; and 3) evaluate the long-term impact of MIDAS
on outcomes related to menopause.
In another study, which was completed in 2008, Sciamanna,176 studied the efficacy of a
computer program that creates: 1) patient-specific physical activity self-help reports for
individuals, and 2) patient-specific reports to prompt and guide physician advice. The study was
designed to assess the effects of the computer-generated physical activity reports (patient and
physician) on the patients' physical activity and endurance fitness over a 6-month period as
compared with usual care.
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Chapter 4. Discussion
1
Summary of Key Findings
We have presented here the results of a systematic review of the literature regarding the
impact of CHI applications. The CHI field is new and still evolving. As such, the literature in this
field is very heterogeneous and challenging to summarize in well-described categories. Our
review identified a total of 162 articles, of which 137 addressed Key Question 1 and 31
addressed Key Question 2. Overall, despite the heterogeneity and limited nature of the literature,
the following themes emerged.
First, while there may be a role for CHI applications to reach consumers at a low cost and
obviate the need for some activities currently performed by humans, it is likely that a more
important role is to enhance the efficacy of interventions currently delivered by humans. Several
studies compared the use of a CHI application with traditional therapy against traditional therapy
alone. Many found that both groups exerted a significant effect on the outcome of interests, yet
the CHI group had even more benefit that traditional therapy alone.
Secondly, in the aggregate, the studies evaluated in this review tended to support the finding
that at least three critical elements are most often found in those CHI applications that exert a
significant impact on health outcomes. These three factors are 1) individual tailoring, 2)
personalization, and 3) behavioral feedback. Personalization involves designing the intervention
to be delivered in a way that makes it specific for a given individual. Tailoring refers to building
an intervention, in part, on specific knowledge of actual characteristics of the individual
receiving the intervention. Finally, behavioral feedback refers to providing consumers with
messages regarding their status, wellbeing, or progression through the intervention. These
messages may come in many different forms. They can be motivational (You did great today!) or
purely data driven (You completed 80 percent of your goal today). Interestingly, it is not clear
from this literature that CHI-derived behavioral feedback is any better than feedback originating
from human practitioners or others. Rather, it appears that the feedback must happen with an
appropriate periodicity, in a format that is appealing and acceptable to the consumer, not just the
provider.
This systematic review found that RCT evaluations to date suggest that CHI applications
may positively impact healthcare processes such as medication adherence among asthmatics.
CHI applications may also positively impact intermediate outcomes across a variety of clinical
conditions and health behaviors, including cancer, diabetes mellitus, mental health disorders,
smoking, diet, and physical activity. CHI applications may not have much impact on
intermediate outcomes among individuals who are obese or suffer with asthma or COPD. The
currently available RCT evidence is more equivocal regarding the impact of CHI applications on
relationship-centered outcomes, while the evidence appears relatively strong in support of the
positive impact of CHI on selected clinical outcomes. (Mental Health) The data are insufficient
to determine the impact of CHI on economic outcomes.
Of note, studies have identified several barriers to utilization of CHI applications. The
barriers include incompatibility with current care practices, professional staff perceptions of
increased workload, poor social support, limited IT knowledge and literacy of consumers,
cultural issues, and concerns about time, privacy, security, and control.
1
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While the use of CHI applications offers significant promise and potential, the nascent
literature has important knowledge gaps that currently preclude claims of proven efficacy or
unquestionably support a value proposition for the use of CHI applications. In the final analysis,
the early work cited in this review is encouraging, but clearly more research is needed to
substantiate these early findings and close the identified gaps in knowledge.
Limitations
This review has several important limitations. First our initial search for eligible studies
proved to be challenging because of inconsistent use of terminology in the literature. We
minimized this problem by searching multiple databases and supplementing our search with a
review of selected journals and querying experts. The most important limitation was marked
heterogeneity of interventions, populations and outcomes, making synthesis across studies
difficult, and precluding meta-analysis. Inconsistent definitions and reporting of outcome
measures further limited our ability to synthesize data, as many studies did not report enough
data to support calculation of effect sizes. Another limitation is related to the design of CHI tools
and applications. Because development involves an iterative process, it is sometimes difficult to
synthesize results across studies. Two studies my have evaluated the same CHI tool or
application however the tool itself may have been adapted or otherwise changed during the
period of time after the first study but prior to the second study. Methodologic limitations of
many of the RCTs limit the strength of conclusions. We evaluated the quality of the study using
the criteria proposed by Jadad.4 We also graded the strength of the body of the scientific
evidence on each section. For a variety of reasons, the strength of the body of evidence was often
graded as low. Because the distinction between CHI and patient-centered HIT has not been
clearly articulated, it was at times challenging to distinguish between consumer HIT and patient-
centered HIT. Patient centered HIT studies were excluded because they will be addressed in a
separate evidence report. Finally, as indicated in the Research in Progress section of the Results
chapter, several studies of CHI applications have been initiated or completed but not yet
reported. The evidence report may need to be updated when the results of these studies are
available.
Future Research Needs

The results of this review indicate that the scientific evidence base regarding the impact of
CHI applications is at a nascent and evolving state. As such, several future research needs can be
identified. More work needs to be done to confirm the preliminary findings identified in this
review. In many areas, only one study has been done on a given question or issue, precluding
definitive conclusions. Across studies, the reporting of the evaluations is non-uniform, often with
critical features of the evaluation methodology or application details entirely lacking. To
facilitate uniform reporting and improve the quality of the work in this field, consideration
should be given to development of a national CHI applications design and development registry
and CHI applications trials registry with uniform reporting requirements. However, the
developers of these applications come from a wide and diverse array of backgrounds. Some have
significant technical expertise while others do not. Furthermore, these studies are reported in a
variety of journals with editors and editorial boards of widely differing technical expertise and
reporting requirements. Research in this multidisciplinary field would be greatly enhanced by an
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accepted vocabulary, nomenclature, or ontology. Currently there is much confusion and blurring
of the lines between the technical platform upon which the application is built along with the
technical specifications of the CHI application in question with both the goals and functions of
the application and the educational or behavioral content included in the application. While a
strict rendering of the current definitions of these elements allows for little conceptual overlap,
the literature is replete with examples of investigators who describe the technical platform
employed in a CHI application (cell phone) when describing the application, which by itself,
sheds little light, regarding the nature of the CHI application. More work will need to be done to
explicate the role of human factors, socio cultural factors, human computer interface issues,
literacy, and gender.
The findings of this review indicate that most CHI research is being primarily conducted
among white/Caucasian adult patients, and it is not clear how the findings apply to non-white
populations. The importance of this limitation is heightened by the fact that the internet will be
the primary means of the consumer’s ability to use and take advantage of CHI tools. While
technological platforms may vary, most CHI applications will, in one way or another, rely on the
internet to perform its functions. Consumer internet familiarity and utilization trends will have
significant impact on the ability of CHI applications to be successful across all consumer
populations. Recent data suggests the internet and technology experiences of whites may not be
the same as individuals from other racial/ethnic backgrounds. Differential experiences across
racial groups may be associated with differential efficacy of a given CHI application and result
in outcomes that are unexpected or unseen among white consumer groups. The evidence
suggests, for example, that Internet and technology utilization has not yet become as essential or
appealing to African-Americans as to whites. Just 36 percent of African-Americans with Internet
access go online on a typical day compared to 56 percent of whites. Whites and blacks even have
differing attitudes toward the internet with online African-Americans not being as fervent in their
appreciation of the Internet as online whites.173 African-American Internet users are also
somewhat more likely than whites to have their Internet access come exclusively through their
jobs. Finally, while online privacy has become a significant concern for a majority of Internet
users, African-Americans tend to be less trusting than whites. They are also more concerned
about their online privacy than whites and these heightened privacy concerns are reflected in
what they choose to do online. Online African-Americans are less likely to participate in high-
trust activities like auctions or to give their credit card information to an online vendor. They are
also less likely than white Internet users to trade their personal information for access to a Web
site. 173 The CHI and health implications of these findings are unclear.
The problem extends beyond African Americans. Fifty-six percent of Latinos in the U.S. use
the Internet. This compares to 71 percent of non- Hispanic whites and 60 percent of non-
Hispanic blacks who use the internet. 173 Among Latinos, the information and communications
revolution is not limited to the computer screen. Some Latinos who do not use the internet are
connecting to the communications superhighway via cell phone. Almost 60 percent (59 percent)
of Latino adults have a cell phone and 49 percent of Latino cell phone users send and receive text
messages on their phone.173
Finally, the issue is not just one of under-utilization or access. Asian-Americans who speak
English are the most wired racial or ethnic group in America. They are also the Internet’s
heaviest and most experienced users. Over 5 million Asian Americans (75 percent) have used the
internet. This compares to 58 percent of whites, 43 percent of African- Americans, and 50
percent of English-speaking Hispanics. 173 Typically Asians spend more time online than other
99
racial and ethnic groups. In addition, they engage the internet at a much higher level of intensity
on a typical day than other groups and, as such, the internet represents an extremely important
and fundament component of daily living for Asian-Americans. Overall, Asian-American men
engage in online activities more than Asian-American women.173 Even beyond race and ethnicity
issues that may affect CHI mediated health outcomes; the importance of family, neighborhood,
and environmental determinants of many clinical health outcomes is increasingly realized. We
need to understand how these factors (social determinants) may impact CHI access, utilization,
efficacy, costs, and/or outcomes at the individual level and healthcare disparities at the
population level. The results of this review indicate that the realities and implications of these
differences have not been adequately evaluated in the current scientific literature and much more
formative and experimental work needs to be done to fill these critical knowledge gaps.
The results of this review also indicate that because most of the evaluative research being done is
being conducted among middle aged adult populations, significant opportunities exist for
additional research among other age groups of consumers. It may even be that the impact of CHI
applications may be greater among non middle aged adult consumers because these consumers
may be most likely to adopt CHI applications (children, adolescents, and young adults) and they
may have the most to gain from using effective CHI applications (elderly).
Similarly, the results of this review indicate that most CHI applications evaluated to date are
designed to run on desktop computers. More work will need to be done to understand the role of
other technological platforms including cell phones, PDA’s, TV, satellite, on Demand, Health
Gaming platforms (Wii, XBOX, Gamecube etc). Related to technological platforms used for
CHI applications is the potential role of social networking applications. Very few currently
evaluated CHI applications explored the dynamics and potential utility of using social
networking applications (Skype, Twitter, MySpace, Facebook, You Tube, blogs, Second life,
Yoville and Farmville etc) to support behavior change or improve health outcomes. While it may
be challenging to envision the elderly twittering, use of these applications may open
opportunities to address health problems impacted by trust, social isolation, cognitive stimulation
and low literacy) This type of research may inevitably lead to a broader array of interactivity
among patients and their caregivers with measurable psychological and physiological health
benefits for users and patients. In so doing, CHI applications may accrue greater appeal and
effectiveness among patients because these applications are assisting patients to address real life
issues that in the past may have been unrecognized barriers to achieving optimal health.
Implications
The results of this review have several important implications. In terms of the currently
engaged and activated consumer, CHI applications and tools may in the future provide additional
tools to facilitate efforts to optimize their health status. The rapid growth and development of the
internet combined with the rapid rise in the use of the internet to search for health related
information suggest that individuals are drawn to use convenient and anonymous technologies
for health purposes. If CHI applications and tools become available in a wider array of platforms,
it may become easier to engage more people who are not actively managing their health.
Although CHI tools and applications, as we have defined them, do not require the involvement
of a healthcare provider, it is likely that significant growth in the utilization of CHI tools will
necessitate increasing provider and healthcare system competency with these emerging tools.
Consumers will increasingly want more interactivity and functionality and the ability to work
100
interactively with traditionally collected health information at the time and place of their
choosing. Providers and healthcare systems that are seen as not equipped to handle or address
these issues are unlikely to be seen as the highest quality or highest performing providers and
systems.
There are may be important implications for health policy decision makers, such as the
National Coordinator of IT. To the extent that CHI applications help improve healthcare process
and clinical outcomes, they cannot be considered outside the domain of the healthcare system or
direct medical care. Growth in this area may necessitate the development of policy positions
which support diffusion of HIT tools and applications among providers and healthcare systems,
but also facilitate the diffusion of CHI tools and applications among healthcare consumers. In
like fashion many state officials and governments have or are currently considering supporting
regional Health Information Exchanges, state wide Electronic Medical Records systems and
other medical technologies. These state level health leaders may soon need to consider
supporting patient use of CHI tools as one strategy to facilitate health promotion. Yet, as the
results of this review indicate, the current state of the scientific literature is promising, but
largely preliminary and thus not able to provide evidence based guidance regarding cost effective
utilization of scarce public or private resource dollars with respect to CHI.
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References and Included Studies
1. Eysenbach G. Consumer health informatics. 11. Guendelman S, Meade K, Benson M, Chen
BMJ 2000; 320(7251):1713-6. YQ, Samuels S. Improving asthma
outcomes and self-management behaviors of
2. Houston JD, Fiore DC. Online medical inner-city children: A randomized trial of
surveys: using the Internet as a research tool. the Health Buddy interactive device and an
MD Comput 1998; 15(2):116-20. asthma diary. 2002; 156(2):114-20.
3. Berlin JA. Does blinding of readers affect 12. Bartholomew LK, Gold RS, Parcel GS et al.
the results of meta-analyses? University of Watch, Discover, Think, and Act:
Pennsylvania Meta-analysis Blinding Study Evaluation of computer-assisted instruction
Group. Lancet 1997; 350(9072):185-6. to improve asthma self-management in
inner-city children. 2000; 39(2-3):269-80.
4. Jadad AR, Moore RA, Carroll D et al.
Assessing the quality of reports of 13. Gustafson DH, Hawkins R, Pingree S et al.
randomized clinical trials: is blinding Effect of computer support on younger
necessary? Control Clin Trials 1996; women with breast cancer. J Gen Intern Med
17(1):1-12. 2001; 16(7):435-45.
5. Atkins D, Best D, Briss PA et al. Grading 14. Gustafson DH, Hawkins R, Mctavish F et al.
quality of evidence and strength of Internet-based interactive support for cancer
recommendations. BMJ 2004; patients: Are integrated systems better?
328(7454):1490. 2008; 58(2):238-57.
6. Methods Reference Manual for Comparative 15. Jones R, Pearson J, McGregor S et al.
Effectiveness Reviews. The Agency for Randomised trial of personalised computer
Healthcare Research and Quality, 2007. based information for cancer patients. BMJ
1999; 319(7219):1241-7.
7. Huss K, Salerno M, Huss RW. Computer-
assisted reinforcement of instruction: effects 16. Waterman AD, Banet G, Milligan PE et al.
on adherence in adult atopic asthmatics. Patient and physician satisfaction with a
1991; 14(4):259-67. telephone-based anticoagulation service. J
Gen Intern Med 2001; 16(7):460-3.
8. Krishna S, Francisco BD, Balas EA, Konig
P, Graff GR, Madsen RW. Internet-enabled 17. Adachi Y, Sato C, Yamatsu K, Ito S, Adachi
interactive multimedia asthma education K, Yamagami T. A randomized controlled
program: a randomized trial. Pediatrics trial on the long-term effects of a 1-month
2003; 111(3):503-10. behavioral weight control program assisted
by computer tailored advice. Behav Res
9. Chewning B, Mosena P, Wilson D et al. Ther 2007; 45(3):459-70.
Evaluation of a computerized contraceptive
decision aid for adolescent patients. Patient 18. Anderson ES, Winett RA, Wojcik JR,
Educ Couns 1999; 38(3):227-39. Winett SG, Bowden T. A computerized
social cognitive intervention for nutrition
10. Jan RL, Wang JY, Huang MC, Tseng SM, behavior: Direct and mediated effects on fat,
Su HJ, Liu LF. An internet-based interactive fiber, fruits, and vegetables, self-efficacy,
telemonitoring system for improving and outcome expectations among food
childhood asthma outcomes in Taiwan. shoppers. 2001; 23(2):88-100.
Telemed J E Health 2007; 13(3):257-68.
19. Brug J, Steenhuis I, Van Assema P, De
Vries H. The impact of a computer-tailored
nutrition intervention. 1996; 25(3):236-42.
103
20. Brug J, Glanz K, Van Assema P, Kok G, 29. Hurling R, Catt M, Boni MD et al. Using
Van Breukelen GJP. The Impact of internet and mobile phone technology to
Computer-Tailored Feedback and Iterative deliver an automated physical activity
Feedback on Fat, Fruit, and Vegetable program: randomized controlled trial. J Med
Intake. 1998; 25(4):517-31. Internet Res 2007; 9(2):e7.
21. Brug J, Steenhuis I, Van Assema P, Glanz 30. Jones M, Luce KH, Osborne MI et al.
K, De Vries H. Computer-tailored nutrition Randomized, controlled trial of an internet-
education: Differences between two facilitated intervention for reducing binge
interventions. 1999; 14(2):249-56. eating and overweight in adolescents.
Pediatrics 2008; 121(3):453-62.
22. Campbell MK, DeVellis BM, Strecher VJ,
Ammerman AS, DeVellis RF, Sandler RS. 31. King DK, Estabrooks PA, Strycker LA,
Improving dietary behavior: The Toobert DJ, Bull SS, Glasgow RE.
effectiveness of tailored messages in Outcomes of a multifaceted physical activity
primary care settings. 1994; 84(5):783-7. regimen as part of a diabetes self-
management intervention. 2006; 31(2):128-
23. Campbell MK, Honess-Morreale L, Farrell 37.
D, Carbone E, Brasure M. A tailored
multimedia nutrition education pilot 32. Kristal AR, Curry SJ, Shattuck AL, Feng Z,
program for low-income women receiving Li S. A randomized trial of a tailored, self-
food assistance. 1999; 14(2):257-67. help dietary intervention: The puget sound
eating patterns study. 2000; 31(4):380-9.
24. Campbell MK, Carbone E, Honess-Morreale
L, Heisler-MacKinnon J, Demissie S, Farrell 33. Lewis B, Williams D, Dunsiger S et al.
D. Randomized trial of a tailored nutrition User attitudes towards physical activity
education CD-ROM program for women websites in a randomized controlled trial.
receiving food assistance. 2004; 36(2):58- Prev Med 2008; 47(5):508-13.
66.
34. Low KG, Charanasomboon S, Lesser J et al.
25. Haerens L, De Bourdeaudhuij I, Maes L, Effectiveness of a computer-based
Vereecken C, Brug J, Deforche B. The interactive eating disorders prevention
effects of a middle-school healthy eating program at long-term follow-up. Eat Disord
intervention on adolescents' fat and fruit 2006; 14(1):17-30.
intake and soft drinks consumption. 2007;
10(5):443-9. 35. Marcus BH, Lewis BA, Williams DM et al.
A comparison of Internet and print-based
26. Haerens L, Deforche B, Maes L, Brug J, physical activity interventions. Arch Intern
Vandelanotte C, De Bourdeaudhuij I. A Med 2007; 167(9):944-9.
computer-tailored dietary fat intake
intervention for adolescents: results of a 36. Mangunkusumo R, Brug J, Duisterhout J, de
randomized controlled trial. Ann Behav Med Koning H, Raat H. Feasibility, acceptability,
2007; 34(3):253-62. and quality of Internet-administered
adolescent health promotion in a preventive-
27. Haerens L, Maes L, Vereecken C, De care setting. Health Educ Res 2007; 22(1):1-
Henauw S, Moreno L, De Bourdeaudhuij I. 13.
Effectiveness of a computer tailored
physical activity intervention in adolescents 37. Napolitano MA, Fotheringham M, Tate D et
compared to a generic advice. Patient Educ al. Evaluation of an internet-based physical
Couns 2009. activity intervention: a preliminary
investigation. Ann Behav Med 2003;
28. Hurling R, Fairley BW, Dias MB. Internet- 25(2):92-9.
based exercise intervention systems: Are 38. Oenema A, Brug J, Lechner L. Web-based
more interactive designs better? 2006; tailored nutrition education: results of a
21(6):757-72. randomized controlled trial. Health Educ
Res 2001; 16(6):647-60.
104
39. Richardson CR, Mehari KS, McIntyre LG et disorders. J Consult Clin Psychol 2000;
al. A randomized trial comparing structured 68(2):346-50.
and lifestyle goals in an internet-mediated
walking program for people with type 2 48. Wylie-Rosett J, Swencionis C, Ginsberg M
diabetes. Int J Behav Nutr Phys Act 2007; et al. Computerized weight loss intervention
4:59. optimizes staff time: The clinical and cost
results of a controlled clinical trial
40. Silk KJ, Sherry J, Winn B, Keesecker N, conducted in a managed care setting. 2001;
Horodynski MA, Sayir A. Increasing 101(10):1155-62.
nutrition literacy: testing the effectiveness of
print, web site, and game modalities. J Nutr 49. National Center for Health Statistics.
Educ Behav 2008; 40(1):3-10. National Health and Nutrition Examination
Survey [Web Page]. Available at
41. Smeets T, Kremers SP, Brug J, de Vries H. http://www.cdc.gov/nchs/about/major/nhane
Effects of tailored feedback on multiple s/growthcharts/GrowthchartFAQs.htm.
health behaviors. Ann Behav Med 2007;
33(2):117-23. 50. Doumas DM, Hannah E. Preventing high-
risk drinking in youth in the workplace: a
42. Spittaels H, De Bourdeaudhuij I, Brug J, web-based normative feedback program. J
Vandelanotte C. Effectiveness of an online Subst Abuse Treat 2008; 34(3):263-71.
computer-tailored physical activity
intervention in a real-life setting. Health 51. Kypri K, Saunders JB, Williams SM et al.
Educ Res 2007; 22(3):385-96. Web-based screening and brief intervention
for hazardous drinking: a double-blind
43. Spittaels H, De Bourdeaudhuij I, randomized controlled trial. Addiction 2004;
Vandelanotte C. Evaluation of a website- 99(11):1410-7.
delivered computer-tailored intervention for
increasing physical activity in the general 52. Neighbors C, Larimer ME, Lewis MA.
population. 2007; 44(3):209-17. Targeting misperceptions of descriptive
drinking norms: efficacy of a computer-
44. Tate DF, Jackvony EH, Wing RR. A delivered personalized normative feedback
randomized trial comparing human e-mail intervention. J Consult Clin Psychol 2004;
counseling, computer-automated tailored 72(3):434-47.
counseling, and no counseling in an Internet
weight loss program. Arch Intern Med 2006; 53. An LC, Klatt C, Perry CL et al. The RealU
166(15):1620-5. online cessation intervention for college
smokers: a randomized controlled trial. Prev
45. Vandelanotte C, De Bourdeaudhuij I, Sallis Med 2008; 47(2):194-9.
JF, Spittaels H, Brug J. Efficacy of
sequential or simultaneous interactive 54. Patten CA, Croghan IT, Meis TM et al.
computer-tailored interventions for Randomized clinical trial of an Internet-
increasing physical activity and decreasing based versus brief office intervention for
fat intake. Ann Behav Med 2005; 29(2):138- adolescent smoking cessation. Patient Educ
46. Couns 2006; 64(1-3):249-58.
46. Verheijden M, Bakx JC, Akkermans R et al. 55. Cunningham JA, Humphreys K, Koski-
Web-based targeted nutrition counselling Jannes A, Cordingley J. Internet and paper
and social support for patients at increased self-help materials for problem drinking: is
cardiovascular risk in general practice: there an additive effect? Addict Behav 2005;
randomized controlled trial. J Med Internet 30(8):1517-23.
Res 2004; 6(4):e44.
56. Hester RK, Squires DD, Delaney HD. The
47. Winzelberg AJ, Eppstein D, Eldredge KL et Drinker's Check-up: 12-month outcomes of
al. Effectiveness of an Internet-based a controlled clinical trial of a stand-alone
program for reducing risk factors for eating software program for problem drinkers. J
Subst Abuse Treat 2005; 28(2):159-69.
105
57. Lieberman DZ. Effects of a personified 66. Prokhorov AV, Kelder SH, Shegog R et al.
guide on adherence to an online program for Impact of A Smoking Prevention Interactive
alcohol abusers. Cyberpsychol Behav 2006; Experience (ASPIRE), an interactive,
9(5):603-7. multimedia smoking prevention and
cessation curriculum for culturally diverse
58. Riper H, Kramer J, Smit F, Conijn B, high-school students. Nicotine Tob Res
Schippers G, Cuijpers P. Web-based self- 2008; 10(9):1477-85.
help for problem drinkers: a pragmatic
randomized trial. Addiction 2008; 67. Severson HH, Gordon JS, Danaher BG,
103(2):218-27. Akers L. ChewFree.com: evaluation of a
Web-based cessation program for smokeless
59. Riper H, Kramer J, Keuken M, Smit F, tobacco users. Nicotine Tob Res 2008;
Schippers G, Cuijpers P. Predicting 10(2):381-91.
successful treatment outcome of web-based
self-help for problem drinkers: secondary 68. Shiffman S, Paty JA, Rohay JM, Di Marino
analysis from a randomized controlled trial. ME, Gitchell J. The efficacy of computer-
J Med Internet Res 2008; 10(4):e46. tailored smoking cessation material as a
supplement to nicotine polacrilex gum
60. Brendryen H, Drozd F, Kraft P. A digital therapy. Arch Intern Med 2000;
smoking cessation program delivered 160(11):1675-81.
through internet and cell phone without
nicotine replacement (happy ending): 69. Schumann A, John U, Rumpf H-J, Hapke U,
randomized controlled trial. J Med Internet Meyer C. Changes in the "stages of change"
Res 2008; 10(5):e51. as outcome measures of a smoking cessation
intervention: A randomized controlled trial.
61. Curry SJ, McBride C, Grothaus LC, Louie 2006; 43(2):101-6.
D, Wagner EH. A randomized trial of self-
help materials, personalized feedback, and 70. Schumann A, John U, Baumeister SE,
telephone counseling with nonvolunteer Ulbricht S, Rumpf HJ, Meyer C. Computer-
smokers. 1995; 63(6):1005-14. tailored smoking cessation intervention in a
general population setting in Germany:
62. Dijkstra A. Working mechanisms of outcome of a randomized controlled trial.
computer-tailored health education: Nicotine Tob Res 2008; 10(2):371-9.
Evidence from smoking cessation. 2005;
20(5):527-39. 71. Strecher VJ, McClure JB, Alexander GL et
al. Web-based smoking-cessation programs:
63. Haug S, Meyer C, Schorr G, Bauer S, John results of a randomized trial. Am J Prev
U. Continuous individual support of Med 2008; 34(5):373-81.
smoking cessation using text messaging: A
pilot experimental study. Nicotine Tob Res 72. Strecher VJ, Shiffman S, West R.
2009. Moderators and mediators of a web-based
computer-tailored smoking cessation
64. Japuntich SJ, Zehner ME, Smith SS et al. program among nicotine patch users.
Smoking cessation via the internet: a Nicotine Tob Res 2006; 8 Suppl 1:S95-101.
randomized clinical trial of an internet
intervention as adjuvant treatment in a 73. Strecher VJ, Marcus A, Bishop K et al. A
smoking cessation intervention. Nicotine randomized controlled trial of multiple
Tob Res 2006; 8 Suppl 1:S59-67. tailored messages for smoking cessation
among callers to the cancer information
65. Prochaska JO, DiClemente CC, Velicer WF, service. J Health Commun 2005; 10 Suppl
Rossi JS. Standardized, Individualized, 1:105-18.
Interactive, and Personalized Self-Help
Programs for Smoking Cessation. 1993; 74. Strecher VJ, Shiffman S, West R.
12(5):399-405. Randomized controlled trial of a web-based
computer-tailored smoking cessation
program as a supplement to nicotine patch
106
therapy. Addiction 2005; 100(5):682-8. Weight management using the internet a
randomized controlled trial. Am J Prev Med
75. Strecher VJ, Kreuter M, Den Boer D-J, 2008; 34(2):119-26.
Kobrin S, Hospers HJ, Skinner CS. The
effects of computer-tailored smoking 86. Cussler EC, Teixeira PJ, Going SB et al.
cessation messages in family practice Maintenance of weight loss in overweight
settings. 1994; 39(3):262-70. middle-aged women through the Internet.
Obesity (Silver Spring) 2008; 16(5):1052-
76. Swartz LH, Noell JW, Schroeder SW, Ary 60.
DV. A randomised control study of a fully
automated internet based smoking cessation 87. Booth AO, Nowson CA, Matters H.
programme. Tob Control 2006; 15(1):7-12. Evaluation of an interactive, Internet-based
weight loss program: a pilot study. Health
77. Reach G. Obstacles to patient education in Educ Res 2008; 23(3):371-81.
chronic diseases: A trans-theoretical
analysis. Patient Educ Couns 2009. 88. Frenn M, Malin S, Brown RL et al.
Changing the tide: An Internet/video
78. Schneider SJ, Walter R, O'Donnell R. exercise and low-fat diet intervention with
Computerized communication as a medium middle-school students. 2005; 18(1):13-21.
for behavioral smoking cessation treatment:
Controlled evaluation. 1990; 6(2):141-51. 89. Taylor CB, Agras WS, Losch M, Plante TG,
Burnett K. Improving the effectiveness of
79. Weinstein ND. The precaution adoption computer-assisted weight loss. 1991;
process. Health Psychol 1988; 7(4):355-86. 22(2):229-36.
80. Kroeze W, Oenema A, Campbell M, Brug J. 90. Burnett KF, Taylor CB, Agras WS.
The efficacy of Web-based and print- Ambulatory computer-assisted therapy for
delivered computer-tailored interventions to obesity: A new frontier for behavior therapy.
reduce fat intake: results of a randomized, 1985; 53(5):698-703.
controlled trial. J Nutr Educ Behav 2008;
40(4):226-36. 91. Morgan PJ, Lubans DR, Collins CE, Warren
JM, Callister R. The SHED-IT Randomized
81. McConnon A, Kirk SF, Cockroft JE et al. Controlled Trial: Evaluation of an Internet-
The Internet for weight control in an obese based Weight-loss Program for Men.
sample: results of a randomised controlled Obesity (Silver Spring) 2009.
trial. BMC Health Serv Res 2007; 7:206.
92. Homko CJ, Santamore WP, Whiteman V et
82. Epstein LH, Valoski A, Wing RR, al. Use of an internet-based telemedicine
McCurley J. Ten-year outcomes of system to manage underserved women with
behavioral family-based treatment for gestational diabetes mellitus. Diabetes
childhood obesity. Health Psychol 1994; Technol Ther 2007; 9(3):297-306.
13(5):373-83.
93. Wangberg SC. An Internet-based diabetes
83. Williamson DA, Walden HM, White MA et self-care intervention tailored to self-
al. Two-year internet-based randomized efficacy. Health Educ Res 2008; 23(1):170-
controlled trial for weight loss in African- 9.
American girls. Obesity (Silver Spring)
2006; 14(7):1231-43. 94. Wise PH, Dowlatshahi DC, Farrant S. Effect
of computer-based learning on diabetes
84. Womble LG, Wadden TA, McGuckin BG, knowledge and control. 1986; 9(5):504-8.
Sargent SL, Rothman RA, Krauthamer-
Ewing ES. A randomized controlled trial of 95. McKay HG, King D, Eakin EG, Seeley JR,
a commercial internet weight loss program. Glasgow RE. The diabetes network internet-
Obes Res 2004; 12(6):1011-8. based physical activity intervention: a
randomized pilot study. Diabetes Care
85. Hunter CM, Peterson AL, Alvarez LM et al. 2001; 24(8):1328-34.
107
Andersson G. Randomized controlled trial
96. Lorig KR, Ritter PL, Laurent DD, Plant K. of internet-based stress management. 2003;
Internet-based chronic disease self- 32(3):151-60.
management: a randomized trial. Med Care
2006; 44(11):964-71. 106. Neil AL, Batterham P, Christensen H,
Bennett K, Griffiths KM. Predictors of
97. Glasgow RE, Boles SM, McKay HG, Feil adherence by adolescents to a cognitive
EG, Barrera M Jr. The D-Net diabetes self- behavior therapy website in school and
management program: long-term community-based settings. J Med Internet
implementation, outcomes, and Res 2009; 11(1):e6.
generalization results. Prev Med 2003;
36(4):410-9. 107. Warmerdam L, van Straten A, Twisk J,
Riper H, Cuijpers P. Internet-based
98. Proudfoot J, Ryden C, Everitt B et al. treatment for adults with depressive
Clinical efficacy of computerised cognitive- symptoms: randomized controlled trial. J
behavioural therapy for anxiety and Med Internet Res 2008; 10(4):e44.
depression in primary care: randomised
controlled trial. Br J Psychiatry 2004; 108. Simon SR, Soumerai SB. Failure of Internet-
185:46-54. based audit and feedback to improve quality
of care delivered by primary care residents.
99. Christensen H, Griffiths KM, Jorm AF. Int J Qual Health Care 2005; 17(5):427-31.
Delivering interventions for depression by
using the internet: randomised controlled 109. Joseph CL, Peterson E, Havstad S et al. A
trial. BMJ 2004; 328(7434):265. web-based, tailored asthma management
program for urban African-American high
100. Hasson D, Anderberg UM, Theorell T, school students. Am J Respir Crit Care Med
Arnetz BB. Psychophysiological effects of a 2007; 175(9):888-95.
web-based stress management system: a
prospective, randomized controlled 110. Nguyen HQ, Donesky-Cuenco D, Wolpin S
intervention study of IT and media workers. et al. Randomized controlled trial of an
BMC Public Health 2005; 5:78. internet-based versus face-to-face dyspnea
self-management program for patients with
101. Chiauzzi E, Brevard J, Thurn C, Decembrele chronic obstructive pulmonary disease:
S, Lord S. MyStudentBody-Stress: an online pilot study. J Med Internet Res 2008;
stress management intervention for college 10(2):e9.
students. J Health Commun 2008;
13(6):555-72. 111. Franck L, Noble G, McEvoy M. Enquiring
minds want to know: topics requested by
102. Schneider AJ, Mataix-Cols D, Marks IM, users of a children's health information
Bachofen M. Internet-guided self-help with website. Patient Educ Couns 2008;
or without exposure therapy for phobic and 72(1):168-71.
panic disorders. Psychother Psychosom
2005; 74(3):154-64. 112. Kukafka R, Lussier YA, Eng P, Patel VL,
Cimino JJ. Web-based tailoring and its
103. Fathelrahman AI, Omar M, Awang R et al. effect on self-efficacy: results from the MI-
Smokers' responses toward cigarette pack HEART randomized controlled trial. Proc
warning labels in predicting quit intention, AMIA Symp 2002; 410-4.
stage of change, and self-efficacy. Nicotine
Tob Res 2009; 11(3):248-53. 113. Chumley HS, Dobbie AE, Delzell JE Jr.
Case-based exercises fail to improve
104. Glasheen JJ, Cumbler EU. Tailoring internal medical students' information management
medicine training to improve hospitalist skills: a controlled trial. BMC Med Educ
outcomes. Arch Intern Med 2009; 2006; 6:14.
169(2):204-5.
105. Zetterqvist K, Maanmies J, Ström L,
108
114. Lorig KR, Ritter PL, Laurent DD, Plant K. versus an audio-booklet decision aid for
The internet-based arthritis self-management women considering post-menopausal
program: a one-year randomized trial for hormone replacement therapy. Patient Educ
patients with arthritis or fibromyalgia. Couns 2002; 46(1):67-74.
Arthritis Rheum 2008; 59(7):1009-17.
124. Yardley L, Nyman SR. Internet provision of
115. Buhrman M, Faltenhag S, Strom L, tailored advice on falls prevention activities
Andersson G. Controlled trial of Internet- for older people: a randomized controlled
based treatment with telephone support for evaluation. Health Promot Int 2007;
chronic back pain. Pain 2004; 111(3):368- 22(2):122-8.
77.
125. Paperny DM, Aono JY, Lehman RM,
116. Oenema A, Brug J, Dijkstra A, de Weerdt I, Hammar SL, Risser J. Computer-assisted
de Vries H. Efficacy and use of an internet- detection and intervention in adolescent
delivered computer-tailored lifestyle high-risk health behaviors. 1990;
intervention, targeting saturated fat intake, 116(3):456-62.
physical activity and smoking cessation: a
randomized controlled trial. Ann Behav Med 126. Simkins CV, Wenzloff NJ. Evaluation of a
2008; 35(2):125-35. computerized reminder system in the
enhancement of patient medication refill
117. Campbell E, Peterkin D, Abbott R, Rogers J. compliance. Drug Intell Clin Pharm 1986;
Encouraging underscreened women to have 20(10):799-802.
cervical cancer screening: the effectiveness
of a computer strategy. Prev Med 1997; 127. James N, Daniels H, Rahman R, McConkey
26(6):801-7. C, Derry J, Young A. A study of
information seeking by cancer patients and
118. Brennan PF, Moore SM, Smyth KA. The their carers. Clin Oncol (R Coll Radiol)
effects of a special computer network on 2007; 19(5):356-62.
caregivers of persons with Alzheimer's
disease. Nurs Res 1995; 44(3):166-72. 128. Green MJ, Peterson SK, Baker MW et al.
Use of an educational computer program
119. Harari D, Iliffe S, Kharicha K et al. before genetic counseling for breast cancer
Promotion of health in older people: a susceptibility: effects on duration and
randomised controlled trial of health risk content of counseling sessions. Genet Med
appraisal in British general practice. Age 2005; 7(4):221-9.
Ageing 2008; 37(5):565-71.
129. Maslin AM, Baum M, Walker JS, A'Hern R,
120. Devineni T, Blanchard EB. A randomized Prouse A. Using an interactive video disk in
controlled trial of an internet-based breast cancer patient support. Nurs Times
treatment for chronic headache. Behav Res 1998; 94(44):52-5.
Ther 2005; 43(3):277-92.
130. Montgomery AA, Emmett CL, Fahey T et
121. Flatley-Brennan P. Computer network home al. Two decision aids for mode of delivery
care demonstration: a randomized trial in among women with previous caesarean
persons living with AIDS. Comput Biol section: randomised controlled trial. BMJ
Med 1998; 28(5):489-508. 2007; 334(7607):1305.
122. Schapira MM, Gilligan MA, McAuliffe T, 131. Sciamanna CN, Harrold LR, Manocchia M,
Garmon G, Carnes M, Nattinger AB. Walker NJ, Mui S. The effect of web-based,
Decision-making at menopause: a personalized, osteoarthritis quality
randomized controlled trial of a computer- improvement feedback on patient
based hormone therapy decision-aid. Patient satisfaction with osteoarthritis care. Am J
Educ Couns 2007; 67(1-2):100-7. Med Qual 2005; 20(3):127-37.
123. Rostom A, O'Connor A, Tugwell P, Wells

G. A randomized trial of a computerized
109
132. Tjam EY, Sherifali D, Steinacher N, Hett S. 142. Gustafson DH, Hawkins R, Boberg E et al.
Physiological outcomes of an internet Impact of a patient-centered, computer-
disease management program vs. in-person based health information/support system.
counselling: A randomized, controlled trial. Am J Prev Med 1999; 16(1):1-9.
2006; 30(4):397-405.
143. Borckardt JJ, Younger J, Winkel J, Nash
133. Orbach G, Lindsay S, Grey S. A randomised MR, Shaw D. The computer-assisted
placebo-controlled trial of a self-help cognitive/imagery system for use in the
Internet-based intervention for test anxiety. management of pain. Pain Res Manag 2004;
Behav Res Ther 2007; 45(3):483-96. 9(3):157-62.
134. March S, Spence SH, Donovan CL. The 144. Simon C, Acheson L, Burant C et al. Patient
Efficacy of an Internet-Based Cognitive- interest in recording family histories of
Behavioral Therapy Intervention for Child cancer via the Internet. Genet Med 2008;
Anxiety Disorders. J Pediatr Psychol 2008. 10(12):895-902.
135. Kerr J, Patrick K, Norman G et al. 145. Paperny DM. Computerized health
Randomized control trial of a behavioral assessment and education for adolescent
intervention for overweight women: impact HIV and STD prevention in health care
on depressive symptoms. Depress Anxiety settings and schools. Health Educ Behav
2008; 25(7):555-8. 1997; 24(1):54-70.
136. Spek V, Cuijpers P, Nyklicek I et al. One- 146. Shaw BR, Dubenske LL, Han JY et al.
year follow-up results of a randomized Antecedent characteristics of online cancer
controlled clinical trial on internet-based information seeking among rural breast
cognitive behavioural therapy for cancer patients: an application of the
subthreshold depression in people over 50 Cognitive-Social Health Information
years. Psychol Med 2008; 38(5):635-9. Processing (C-SHIP) model. J Health
Commun 2008; 13(4):389-408.
137. Proudfoot J, Goldberg D, Mann A, Everitt
B, Marks I, Gray JA. Computerized, 147. Owen JE, Klapow JC, Roth DL, Nabell L,
interactive, multimedia cognitive- Tucker DC. Improving the effectiveness of
behavioural program for anxiety and adjuvant psychological treatment for women
depression in general practice. Psychol Med with breast cancer: the feasibility of
2003; 33(2):217-27. providing online support. Psychooncology
2004; 13(4):281-92.
138. Consolidated Standards of Reporting Trials
(CONSORT) [Web Page]. Available at 148. McTavish FM, Gustafson DH, Owens BH et
http://www.consort-statement.org/. al. CHESS: An interactive computer system
for women with breast cancer piloted with
139. Tarraga L, Boada M, Modinos G et al. A an under-served population. Proc Annu
randomised pilot study to assess the efficacy Symp Comput Appl Med Care 1994; 599-
of an interactive, multimedia tool of 603.
cognitive stimulation in Alzheimer's disease.
J Neurol Neurosurg Psychiatry 2006; 149. Stock SE, Davies DK, Davies KR,
77(10):1116-21. Wehmeyer ML. Evaluation of an application
for making palmtop computers accessible to
140. Katz RC, Wertz RT. The efficacy of individuals with intellectual disabilities. J
computer-provided reading treatment for Intellect Dev Disabil 2006; 31(1):39-46.
chronic aphasic adults. J Speech Lang Hear
Res 1997; 40(3):493-507. 150. Weber B, Fritze J, Schneider B, Simminger
D, Maurer K. Computerized self-assessment
141. Trautmann E, Kro?ner-Herwig B. Internet- in psychiatric in-patients: acceptability,
based self-help training for children and feasibility and influence of computer
adolescents with recurrent headache: A pilot attitude. Acta Psychiatr Scand 1998;
study. 2008; 36(2):241-5. 98(2):140-5.
110
151. Zeman L, Johnson D, Arfken C, Smith T, do patients do with access to their medical
Opoku P. Lessons learned: challenges records? Stud Health Technol Inform 2001;
implementing a personal digital assistant 84(Pt 2):1440-4.
(PDA) to assess behavioral health in primary
care. Families, Systems & Health: The 161. Keselman A, Slaughter L, Smith CA et al.
Journal of Collaborative Family HealthCare Towards consumer-friendly PHRs: patients'
2006; 24(3):286-98. experience with reviewing their health
records. AMIA Annu Symp Proc 2007; 399-
152. Morak J, Schindler K, Goerzer E et al. A 403.
pilot study of mobile phone-based therapy
for obese patients. J Telemed Telecare 2008; 162. Lober WB, Zierler B, Herbaugh A et al.
14(3):147-9. Barriers to the use of a personal health
record by an elderly population. AMIA
153. Steele R, Mummery KW, Dwyer T. Annu Symp Proc 2006; 514-8.
Development and process evaluation of an
internet-based physical activity behaviour 163. Nijland N, van Gemert-Pijnen J, Boer H,
change program. Patient Educ Couns 2007; Steehouder MF, Seydel ER. Evaluation of
67(1-2):127-36. internet-based technology for supporting
self-care: problems encountered by patients
154. Ferney SL, Marshall AL. Website physical and caregivers when using self-care
activity interventions: preferences of applications. J Med Internet Res 2008;
potential users. Health Educ Res 2006; 10(2):e13.
21(4):560-6.
164. Shaw MJ, Beebe TJ, Tomshine PA, Adlis
155. Cavan DA, Everett J, Plougmann S, SA, Cass OW. A randomized, controlled
Hejlesen OK. Use of the Internet to optimize trial of interactive, multimedia software for
self-management of type 1 diabetes: patient colonoscopy education. 2001;
preliminary experience with DiasNet. 2003; 32(2):142-7.
9 Suppl 1.
165. Ferrer-Roca O, Cárdenas A, Diaz-Cardama
156. Feil EG, Glasgow RE, Boles S, McKay HG. A, Pulido P. Mobile phone text messaging in
Who participates in internet-based self- the management of diabetes. 2004;
management programs? A study among 10(5):282-5.
novice computer users in a primary care
setting. 2000; 26(5):806-11. 166. Bryce CL, Zickmund S, Hess R et al. Value
versus user fees: perspectives of patients
157. Temesgen Z, Knappe-Langworthy JE, St before and after using a web-based portal for
Marie MM, Smith BA, Dierkhising RA. management of diabetes. Telemed J E
Comprehensive Health Enhancement Health 2008; 14(10):1035-43.
Support System (CHESS) for people with
HIV infection. AIDS Behav 2006; 10(1):35- 167. Boberg EW, Gustafson DH, Hawkins RP et
40. al. Development, acceptance, and use
patterns of a computer-based education and
158. Jenkinson J, Wilson-Pauwels L, Jewett MA, social support system for people living with
Woolridge N. Development of a hypermedia AIDS/HIV infection. 1995; 11(2):289-311.
program designed to assist patients with
localized prostate cancer in making 168. Kressig RW, Echt KV. Exercise prescribing:
treatment decisions. J Biocommun 1998; Computer application in older adults. 2002;
25(2):2-11. 42(2):273-7.
159. Lahdenpera TS, Kyngas HA. Patients' views 169. Lenert L, Muñoz RF, Stoddard J et al.
about information technology in the Design and pilot evaluation of an internet
treatment of hypertension. J Telemed smoking cessation program. 2003; 10(1):16-
Telecare 2000; 6(2):108-13. 20.
160. Cimino JJ, Patel VL, Kushniruk AW. What
111
170. Gibbons MC. A historical overview of Gibbons, MD, MPH. eHealth Solutions for
health disparities and the potential of Healthcare Disparities. NY: Springer, 2008.
eHealth solutions. J Med Internet Res 2005;
7(5):e50. 174. Lorig KR. Internet diabetes self
management evaluation (project status -
171. Christakis DA. Internet based patient- completed 2008), National Institute of
centered asthma management system Diabetes and Digestive and Kidney Disease.
(Project Status - Ongoing 2010), National
Heart, Lung and Blood Institute, 175. Col NF. Menopause Interactive Decision
R01HL079402-01A2. Aid System (project status - completed
2005), Agency for Healthcare Research and
172. Brennan P, Downs S. Health Design; Quality.
Rethinking the power and potential of
Personal Health Records, Round One Final 176. Sciamanna CN. Computerized physical
Report 2009. 2009. activity promotion in primary care - II
(project status-completed 2008), National
173. Gibbons M, Edited by Michael Christopher Heart, Lung, and Blood Institute.
112
Appendix A
Appendix A: List of Acronyms
Acronym Definition
ADAS-Cog Alzheimer’s disease assessment scale-cognitive
AHQ Anxiety hierarchy questionnaire
AHRQ Agency for Healthcare Research and Quality
AMIA American medical informatics association
ANCOVA Analysis of covariance
APHA America public health association
ASMP Arthritis self-management program
ASQ Attributional style questionnaire
BAI Beck Anxiety inventory
BDI Beck Depression inventory
BMI Body mass index
BtB Beating the Blues
CBT Cognitive behavioral theory
CESD Center for Epidemiologic Studies-Depression
CES-D Center for Epidemiologic Studies Depression
CgA Chromogranin A
ChEIs Cholinesterase inhibitors
CHESS Comprehensive health enhancement support system
CHI Consumer health informatics
CI Confidence interval
CoNeg Composite index for positive situations
CoPos Composite index for negative situations
DHEA-S Dehydroepiandosterone sulphate
DSMP Dyspnea self-management programs
DXA Dual-energy x-ray absorptiometry
EPC Evidence-based Practice Center
EPSI Exam problem-solving inventory
FFB Kristal Fat and Fiber Behavior
HDS Health distress scale
IEEE Institute of Electrical and Electronics Engineers
IET Industrial engineering technology
IMIS Interactive multimedia internet-based system
IPP Integrated psychostimulation program
ISI International standards institute
IT Information technology
MeSH Medical subject heading
MMSE Mini-mental state examination
NET Internet-based CBT
NPY Neuropeptide Y
PCS Perceived competence scales
PDA Personal digital assistant
PDF Portable document format
RCT Randomized controlled trial
SB2-BED Student bodies 2-binge eating disorder
SD Standard deviation
SDSCA Summary of Diabetes Self Care Activities
TAI Test anxiety inventory
TEP Technical expert panel
TNFα Tumor necrosis factor α
WHO World Health organization
WSAS Work and Social Adjustment Scale
A-1
Appendix B
Appendix C
Database Terms Date Returns
PubMed ((("Medical Informatics Applications"[Mesh] OR "Informatics"[Mesh] OR June1st, 14561

"medical informatics"[mh] OR telemedicine[mh] OR informatics[tiab] OR 2009
internet[tiab] OR internet[mh] OR "Consumer Health Information"[Mesh]
OR "Support systems"[tiab]) AND (consumer[tiab] OR "Patients"[Mesh]
OR patients[tiab] OR patient[tiab] OR parents[mh] OR parents[tiab] OR
parent[tiab] OR "age groups"[mh] OR Caregivers[mh] OR caregiver[tiab]
OR "care giver"[tiab] OR "persons"[mh] OR persons[tiab] OR
person[tiab] OR people[tiab] OR individual[tiab] OR individuals[tiab])
AND English[lang] AND ("randomized controlled trial"[pt] OR
"randomized controlled trials as topic"[mh] OR "randomized controlled
trial"[tiab] OR "randomised controlled trial"[tiab] OR "controlled trial"[tiab]
OR "clinical trial"[tiab]) NOT (editorial[pt] OR letter[pt] OR comment[pt])
NOT (animal[mh] NOT human[mh]) AND (("1900/01/01"[PDat] :
"2009/06/01"[PDat])))
OR
(("Medical Informatics Applications"[Mesh] OR "Informatics"[Mesh] OR
"medical informatics"[mh] OR telemedicine[mh] OR informatics[tiab] OR
internet[tiab] OR "internet"[MeSH Terms] OR "Consumer Health
Information"[Mesh] OR "Support systems"[tiab]) AND (consumer[tiab]
OR "Patients"[Mesh] OR patients[tiab] OR patient[tiab] OR
"parents"[MeSH Terms] OR parents[tiab] OR parent[tiab] OR "age
groups"[mh] OR "caregivers"[MeSH Terms] OR caregiver[tiab] OR "care
giver"[tiab] OR "persons"[mh] OR persons[tiab] OR person[tiab] OR
people[tiab] OR individual[tiab] OR individuals[tiab]) AND (Access[tiab]
OR barrier[tiab] OR facilitator[tiab] OR compatibility[tiab] OR
incompatibility[tiab] OR "user-centered"[tiab] OR "user centered"[tiab]
OR "work flow"[tiab] OR workflow[tiab] OR "reimbursement
mechanisms"[mh] OR reimbursement[tiab] OR "attitude to
computers"[mh] OR attitude[tiab] OR "health knowledge, attitudes,
practice"[mh] OR "computer literacy"[mh] OR (computer[tiab] AND
literacy[tiab])) AND English[lang] NOT (editorial[pt] OR letter[pt] OR
comment[pt]) NOT ("animals"[MeSH Terms] NOT "humans"[MeSH
Terms]) AND (("1900/01/01"[PDat] : "2009/06/01"[PDat]))) AND
(("1900/01/01"[PDat] : "2009/06/01"[PDat])))
EMBASE (('informatics':ti,ab OR telemedicine:ti,ab OR internet:ti,ab OR 'consumer 1421
health information':ti,ab) AND (consumer:ti,ab OR 'patients':ti,ab OR
parents:ti,ab OR 'age groups':ti,ab OR caregivers:ti,ab) AND
('randomized controlled trial':ti,ab OR (controlled:ti,ab AND trial:ti,ab) OR
(clinical:ti,ab AND trial:ti,ab))) OR (('informatics':ti,ab OR
telemedicine:ti,ab OR internet:ti,ab OR 'consumer health
information':ti,ab) AND (consumer:ti,ab OR 'patients':ti,ab OR
parents:ti,ab OR 'age groups':ti,ab OR caregivers:ti,ab) AND
(access:ti,ab OR barrier:ti,ab OR facilitator:ti,ab OR compatibility:ti,ab
OR incompatibility:ti,ab OR 'user centered':ti,ab OR 'work flow':ti,ab OR
reimbursement:ti,ab OR attitude:ti,ab OR (computer:ti,ab AND
literacy:ti,ab))) AND ([article]/lim OR [editorial]/lim OR [review]/lim) AND
[english]/lim AND [humans]/lim
Cochrane (("Medical Informatics applications":ti,ab,kw or "Informatics":ti,ab,kw or 3716
Library (telemedicine):ti,ab,kw or (internet):ti,ab,kw or "Consumer Health
Information":ti,ab,kw or “Support systems”:ti,ab,kw) AND
((consumer):ti,ab,kw or "Patients":ti,ab,kw or (parents):ti,ab,kw or "age
groups":ti,ab,kw or (Caregivers):ti,ab,kw) AND ((randomized controlled
trial):ti,ab,kw or (controlled trial):ti,ab,kw or (clinical trial):ti,ab,kw))
OR
(("Medical Informatics applications":ti,ab,kw or "Informatics":ti,ab,kw or
(telemedicine):ti,ab,kw or (internet):ti,ab,kw or "Consumer Health
Information":ti,ab,kw or “Support systems”:ti,ab,kw) AND
((consumer):ti,ab,kw or "Patients":ti,ab,kw or (parents):ti,ab,kw or "age
groups":ti,ab,kw or (Caregivers):ti,ab,kw) AND ((Access):ti,ab,kw or
C-1
(barrier):ti,ab,kw or (facilitator):ti,ab,kw or (compatibility):ti,ab,kw or

(incompatibility):ti,ab,kw or "user centered":ti,ab,kw or "work
flow":ti,ab,kw or Reimbursement:ti,ab,kw or "attitude to
computers":ti,ab,kw or “computer literacy”:ti,ab,kw))
SCOPUS ((TITLE-ABS-KEY("Medical Informatics applications") OR TITLE-ABS- 5577
KEY(telemedicine) OR TITLE-ABS-KEY(internet) OR TITLE-ABS-
KEY("Consumer Health Information")) AND (TITLE-ABS-KEY(consumer)
OR TITLE-ABS-KEY("Patients") OR TITLE-ABS-KEY(caregivers)) AND
(TITLE-ABS-KEY("randomized controlled trial") OR TITLE-ABS-
KEY(“clinical trial”))) OR ((TITLE-ABS-KEY("Medical Informatics
applications") OR TITLE-ABS-KEY(telemedicine) OR TITLE-ABS-
KEY(internet) OR TITLE-ABS-KEY("Consumer Health Information"))
AND (TITLE-ABS-KEY(consumer) OR TITLE-ABS-KEY("Patients") OR
TITLE-ABS-KEY(caregivers)) AND (TITLE-ABS-KEY(access) OR TITLE-
ABS-KEY(barrier) OR TITLE-ABS-KEY(facilitator) OR TITLE-ABS-
KEY("user centered") OR TITLE-ABS-KEY("attitude to computers") OR
TITLE-ABS-KEY(“computer literacy”) OR TITLE-ABS-KEY(“health
knowledge, attitudes, practice”))) AND (LIMIT-TO(DOCTYPE, "ar") OR
LIMIT-TO(DOCTYPE, "re") OR LIMIT-TO(DOCTYPE, "rp")) AND (LIMIT-
TO(LANGUAGE, "English"))
CINAHL ((TX "Informatics" or TX telemedicine or TX internet or TX "Consumer 1462

Health Information" or TX “Support systems”) AND (TX consumer or TX
"Patients" or TX parents or TX "age groups" or TX Caregivers) AND (TX
"randomized controlled trial" or TX “controlled trial” or TX “clinical trial”) )
OR ((TX "Informatics" or TX telemedicine or TX internet or TX
"Consumer Health Information" or TX “Support systems”) AND (TX
consumer or TX "Patients" or TX parents or TX "age groups" or TX
Caregivers) AND (TX Access or TX barrier or TX facilitator or TX
compatibility or TX incompatibility or TX "user centered" or TX "work
flow" or TX Reimbursement or TX Attitude or TX “computer literacy”)
)NOT ((PT editorial )or (PT letter) or (PT comment))
C-2
Appendix D: Grey Literature Detailed Search Strategies
Database Terms
Health Services Research Projects in Progress (((informatics OR internet OR consumer health

information) AND (consumer OR patients OR parents
OR caregivers) AND (randomized controlled trial OR
clinical trial)) OR ((informatics OR internet OR
consumer health information) AND (consumer OR
patients OR parents OR caregivers) AND (access OR
barrier OR facilitator OR compatibility OR user
centered)))
IEEE CNF IEEE Conference Proceeding ((((((informatics or internet or consumer health information)
IET CNF IET Conference Proceeding and (consumer or patients or parents or caregivers) and
(randomized controlled trial or clinical trial)) or ((informatics or
internet or consumer health information) and (consumer or
patients or parents or caregivers) and (access or barrier or
facilitator or compatibility or user centered))))<in>metadata))
<and> (pyr >= 1990 <and> pyr <= 2009)
Proceedings of the American Society for informatics OR “health information” OR “consumer health
Information Science and Technology (Wiley information” OR internet
InterScience)
WHO –International Clinical Trials Registry informatics applications OR consumer health information OR
Platform internet
American Public Health Association (APHA) Consumer health information OR health information OR
2000-2008 consumer
OpenSIGLE - System for Information on Grey (((informatics OR internet OR consumer health information)
Literature in Europe AND (consumer OR patients OR parents OR caregivers)
AND (randomized controlled trial OR clinical trial)) OR
((informatics OR internet OR consumer health information)
AND (consumer OR patients OR parents OR caregivers)
AND (access OR barrier OR facilitator OR compatibility OR
user centered)))
The New York Academy of Medicine – Grey informatics OR "consumer health information" OR "health info
Literature rmation application"
D-1
Appendix E
SRS Form Page 1 of 2
Previewing Only: You cannot submit data from this form
Previewing at Level 2
Refid: 1, Simon, C., Acheson, L., Burant, C., Gerson, N., Schramm, S., Lewis, S., and Wiesner, G., Patient interest in recording
family histories of cancer via the Internet, Genet Med, 10(12), 2008, p.895-902
State: Ok, Level: KQ 1 CHI (categorical variables), KQ 1 CHI (continuous variables), Jadad -- RCT quality
Submit Data
Key Question 1: What evidence exisits Key Question 2: What are the barriers/facilitators that
that CHI applications impact: clinicians, developers, and consumers and their families or
a. health care processes (e.g., receipt caregivers encounter that limit implimentation of CHI
of appropriate treatment) applications?
b. intermediate outcomes (e.g., self-
management, knowledge, health
behaviors)
c. relationship-centered outcomes
(e.g., shared decision making,
clinician-patient communication)
d. clinical outcomes (e.g., quality of
life)
e. economic outcomes (e.g., cost,
access to care)
1. Does the abstract POTENTIALLY apply to Key Question 1 OR Key Question 2?
Yes (go to Question 2)
No (Go to Question 3 and optionally 4)
Unclear or No Abstract available (Go to Question 5)

Clear Selection
2. This abstract POTENTIALLY applies to:
Key Question 1 (must be an RCT to apply to KQ1)
Key Question 2 (addresses DIRECT barriers to CHI)
Key Question 2 (addresses barriers NOT specific to CHI)
If you have chosen any of the answers to question 2 (reasons for inclusion), SUBMIT. If you believe the abstract should be EXCLUDED, or you are
UNCLEAR/or no abstract is available, please proceed.
3. Reason for Exclusion
No health informatics application
Health informatics application does not apply to the consumer
Health informatics application is for general information only (e.g., general website, message
board, survey, etc.) AND is not tailored to the individual consumer
Study of a "point of care" device (requires a clinician to use or obtain and is part of the regular
provision of care; e.g., device or telemedicine used at the point of care)
No original data (letter to the editor, comment, systematic review)
NOT a randomized controlled trial (this is ONLY an exclusion for KQ1, any article that may apply
to KQ2 should NOT be excluded based on study design)
Other
Non-English (specify language)
4. FLAG excluded article:
http://srsnexus.com/d2d/ul1/review.asp?mode=previewMode&articleid=1&level=2 05/01/2009
(these answers are optional and should only be chosen if one of the above reasons for exclusion have been
identified)
Article of interest: use for background information
Review of a relevant topic: pull for further evaluation of relevance to this review
Other article of intereste: team members may flag personal articles of interest
Clear Selection
If you have chosen any of the answers to question 3 or optionally 4 (reasons for exclusion), SUBMIT. If you are UNCLEAR/or no abstract is
available, please proceed.
5. Relevance to Key question 1 OR 2 is UNCLEAR or no abstract is available.
Unable to determine eligibility based on the abstract alone: INCLUDE (move to next level for assessment)
No Abstract: Title may apply to one of the Key Questions: INCLUDE (move to next level for assessment)
No Abstract: Based on title, journal, and number of pages, this is a letter tot the editor, commentary, or other publication type
that does not contain peer-reviewed data. EXCLUDE
Clear Selection
6. Comments
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Refid: 1, Simon, C., Acheson, L., Burant, C., Gerson, N., Schramm, S., Lewis, S., and Wiesner, G., Patient interest in recording family histories of cancer via the Internet, Genet Med, 10(12), 2008, p.895-902
Save to finish later Submit Data

GENERAL study and population characteristics
1. After full review of this article, does it apply to, and contain abstractable data to answer either Key Question1, or Key Question 2, or both?
If you answer "no" please contact Renee (rwilsob@jhmi.edu) immeditately with the refID.
Yes Key Question 1 (go to question 2)
Yes Key Question 2 (go to question 3)
NO--does nto apply to either key question (contact Renee)

2.
If this article applies to Key Question 1 (outcomes), please identify the subquestion it applies to:
a. Healthcare process outcomes (e.g., diagnosis, treametn, prevetnion)
b. Intermediate outcomes (e.g., self management, health knowledge, health behaviors)
c. Relationship-centered outcomes (e.g., shared decision makig, communication)
d. Clinical outcomes (e.g., quailty of life, safety)
e. Economic outcomes (e.g., cost, access, reimbursement)
f. Other (specifiy)
3. If this article applies to Key Question 2 (barriers), please identify the type or types of barriers it applies to:
system-level barriers (e.g., not user-centric, inefficient workflow, incompatible with other systems, lack of or inadequate reinmbursement)
Individual-level barrier (e.g., negative or opposing attitudes, lack of access, lack o for inadequate reimbursement, lack of knowledge, limited literacy)
Other (specify)
4.
Study design
RCT (ALL KQ 1 articles MUST be RCTs)
Other: define as identified by study authors)

Clear Selection
5.
Study location
Home/residence
Remote location (e.g, library, internet cafe); specify
Clinician office
Not specified
Other; specifcy
6.
Year data collection began
Year
Not specified
Duration
Clear Selection
7.
Who is the consumer?
Individual interested in their own health care (add details if necessary)
Non-medical caregiver (add details)

8. Identify the CHI application type:
Patient kiosk
Personal monitoring device
Disease specific sensor
Interactive consumer website
Disease risk calculator
Personalized health risk assessment tool
Electronic medication reminder
Other (specify)
Clear Selection
9. Identifythe target condition, behavior, or barrier of interest.
(barriers should be listed as free text at teh end of the list of choices)
Obesity
Smoking
Cancer (breast)
Diabetes
Hypertension
Asthma
Mental health
Depression
Substance abuse
Alcohol abuse
other (specify)
Breast (other)
menopause/HRT
Diet/exercise/pysical activity NOT obesity
HIV/AIDS
BARRIER
Study participant inclusion/exclusion criteria (as defined in the article):

Inclusion Exclusion Not specified
10. Age (specify)

11. Race (specify)
12. Gender (specify)
13. Other (specify)
14. Other (specify)
15. Other (specify)
16. Other (specify)
17. Other (specify)
18. Other (specify)
19. Other (specify)
20. Other (specify)
Specify ALL OUTCOMES and ALL TIME POINTS measured in this study.
Be carful to categorize oucomes properly; thi swill impact which form reviewers will fill out next.
Are CATEGORICAL outcomes being studied? Are CONTINUOUS outcomes being studied? Identify (define) the timepoints where outcomes are measured.
Describe below Describe below always use time point 1 as the baseline measure
always use time point 6 as the final measure
Yes Yes
No No
Clear Selection Clear Selection
Cat outcome 1 Cont outcome 1 Time point 1: always define as

baseline
Cat outcome 2 Cont outcome 2 Time point 2: define
Cat outcome 5 Cont outcome 5 Time point 5 define
Cat outcome 7 Cont outcome 7
Define ALL Study Arms

Define No control group
26. ARM A (control group) Clear
27. ARM B (intervention) Clear
28. ARM C (intervention) Clear
29. ARM D (intervention) Clear
Study population characteristics:

ARM Age Race/Ethnicity Annual Income Education Socioeconomic status Other 1 Other 2 Other 3 Other 4
answers from above questions will populate these cells if information is provided and it does not fit the NIH criteria, fill in the "other" categories at the bottom of the cell always identify units, always identify income range as reported in the article OR mean, meadian, SD
ARM A (control group)
Define Mean Race not stated Not specified Not reported Not specified Define Define Define Define
No control group Median White, non-hispanic, n UNITS Less than 8 years, n(%) Low {define}, n(%) category 1, n(%) category 1, n(%) category 1, n(%) category 1, n(%)
Clear Selection Range White, non-hispanic, % income range, n (%) 8-12 years, n(%) Middle {define}, n(%) category 2, n(%) category 2, n(%) category 2, n(%) category 2, n(%)
SD Black, non-hispanic, n income range, n (%) 12-16 years, n(%) High {define}, n(%) category 3, n(%) category 3, n(%) category 3, n(%) category 3, n(%)
Black, non-hispanic, % income range, n (%) >16 years, n(%) category 4, n(%) category 4, n(%) category 4, n(%) category 4, n(%)
Latino/hispanic, n income range, n (%) Mean Mean Mean Mean Mean
Latino/hispanic, % income range, n (%) Median Median Median Median Median
Asian/Pacific Islander, n Mean income SD SD SD SD SD
Asian/Pacific Islander, % Median income

American Indian/Alaska Native, SD
n
American Indian/Alaska Native,
%
Other, n
Other, %
Other, n
Other, %
ARM B (intervention)
Clear Selection Median White, non-hispanic, n UNITS Less than 8 years, n(%) Low {define}, n(%) category 1, n(%) category 1, n(%) category 1, n(%) category 1, n(%)
Range White, non-hispanic, % income range, n (%) 8-12 years, n(%) Middle {define}, n(%) category 2, n(%) category 2, n(%) category 2, n(%) category 2, n(%)

n
%
Other, n
Other, %
Other, n
Other, %
ARM C (intervention)

n
%
Other, n
Other, %
Other, n
Other, %
ARM D (intervention)

n
%
Other, n
Other, %
Other, n
Other, %
70.
Comment
Enlarge Shrink
Click a link below to review this article at these other levels.
5. KQ 1 CHI (categorical variables)
6. KQ 1 CHI (continuous variables)
7. KQ 2 CHI barriers
8. Jadad -- RCT quality
Form Last Modified: Mar 27 2009 4:00PM

KEY QUESTION 1
Report CATEGORICAL variables
What evidence exists that consumer health informatics applications impact health care process outcomes, intermediate outcomes, relationship-centered outcomes, clinical outcomes, or
economic outcomes of its users?
Description of all CATEGORICAL outcomes being studied Identify (define) the timepoints where outcomes are measured.
always use time point 1 as the baseline measure
1. 2.
Cat outcome 1 Baseline
Cat outcome 2 Time point 2: define
Cat outcome 5 Time pint 5: define (ALWAYS use this timepoint as the last/main
measure timepoint when abstracting data)
Cat outcome 6
CATEGORICAL Outctomes
see answers to question 1
Cat Outcome 1
ARM Total N in ARM n with outcome % with outcome 95% CI P Comment
ARM A (control)
N N at n at % at 95% CI P at
randomized baseline baseline baseline at baseline
to this ARM N at time n at time % at time baseline P at time
point 2 point 2 point 2 95% CI point 2 Enlarge
N at time n at time % at time at time P at time Shrink
point 3 point 3 point 3 point 2 point 3
N at time n at % at time 95% CI P at time
point 4 timepoint point 4 at time point 4
4 point 3
N at % at P at
final/main n at final/main 95% CI final/main
measure final/main measure at time measure
measure point 4
95% CI
at
final/main
measure
ARM B
N at n at % at 95% CI P at
Define baseline baseline baseline baseline
at
N N at time n at time % at time baseline P at time
randomized point 2 point 2 point 2 95% CI point 2 Enlarge
to this ARM N at time n at time % at time at time P at time Shrink
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM C
Define baseline baseline baseline at baseline
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM D
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
Cat Outcome 2
ARM A (control)
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM B
Define baseline baseline baseline
baseline at
to this ARM N at time % at time at time P at time Shrink
n at time
4 point 3
N at % at P at
final/main final/main 95% CI final/main
measure n at measure at time measure
final/main point 4
measure 95% CI
at
final/main
measure
ARM C
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM D
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
Cat Outcome 3
ARM A (control)
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM B
Define N at n at % at 95% CI P at
baseline baseline baseline at baseline
to this ARM at time Shrink
N at time n at time % at time P at time
4 point 3
N at % at 95% CI P at
final/main n at final/main at time final/main

measure final/main measure point 4 measure
measure 95% CI
at
final/main
measure
ARM C
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM D
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
Cat Outcome 4
ARM A (control)
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM B
to this ARM at time Shrink
N at time n at time % at time P at time
95% CI
N at time n at % at time at time P at time
point 4 timepoint point 4 point 3 point 4

4
final/main final/main final/main at time final/main
measure measure measure point 4 measure
95% CI
at
final/main
measure
ARM C
Define
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM D
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
Cat Outcome 5
ARM A (control)
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM B
randomized point 2 point 2 point 2 point 2 Enlarge
to this ARM 95% CI

N at 4 % at point 3 P at
measure point 4
95% CI
at
final/main
measure
ARM C
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM D
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
Cat Outcome 6
ARM A (control)
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM B
Define

randomized point 2 point 2 point 2 point 2
to this ARM N at time n at time % at time 95% CI P at time
point 3 point 3 point 3 at time point 3 Enlarge
point 2
N at time n at % at time P at time Shrink
point 4 timepoint point 4 95% CI point 4
4 at time
N at % at point 3 P at
final/main n at final/main final/main
measure final/main measure 95% CI measure
measure at time
point 4
95% CI
at
final/main
measure
ARM C
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
ARM D
4 point 3
N at % at P at
measure point 4
95% CI
at
final/main
measure
171.
COMMENTS
Enlarge Shrink
4. GENERAL study and population characteristics
Form Creation Date: Mar 24 2009 12:27PM
Form Last Modified: Apr 14 2009 9:45AM

KEY QUESTION 1
Report CONTINUOUS variables
What evidence exists that consumer health informatics applications impact health care process outcomes, intermediate outcomes, relationship-centered outcomes, clinical outcomes, or economic outcomes of its users?
Description of all CONTINUOUS outcomes being studied Identify (define) the timepoints where outcomes are measured.
always use time point 1 as the baseline measure
1. 2.
Cont outcome 1 Time point: baseline
Cont outcome 2 Time point 2: define

Time point: final/main
Cont outcome 5
measure
Cont outcome 6
Cont outcome 7
Cont outcome 8
CONTINUOUS Outctome 1 (see answers to question 2)

ARM Total N in ARM n in ARM with outcome Units Value Mean, Median, Range, SD RR or OR (specifiy) Significance Comment
ARM A (control)
N randomized N at n at baseline Units value at mean at RR or OR significance at
to this Arm baseline (define) baseline baseline (specify) at baseline
N at time n at time value at time median at baseline significance at
point 2 point 2 point 2 baseline RR or OR time point 2 Enlarge
N at time n at time value at time range at (specify) at time significance at Shrink
point 3 point 3 point 3 baseline point 2 time point 3
N at time n at time value at time SD at RR or OR significance at
point 4 point 4 point 4 baseline (specify) at time time point 4
n at point 3
N at value at mean at time significance at
final/main final/main final/main point 2 RR or OR final.main
measure measure measure (specify) at time measure
median at point 4
time point 2
RR or OR
range at time (specify) at
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
N at Units value at mean at RR or OR significance at
Define n at baseline
baseline (define) baseline baseline (specify) at baseline
N randomized N at time n at time value at time median at baseline significance at
to this Arm point 2 point 2 point 2 baseline RR or OR time point 2 Enlarge
N at time n at time value at time SD at significance at
point 4 RR or OR
point 4 point 4 baseline (specify) at time time point 4
N at n at value at mean at time point 3 significance at

measure measure measure median at (specify) at time measure
time point 2 point 4
range at time RR or OR
point 2 (specify) at
SD at time final/main
point 2 measure
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
N at n at baseline Units value at mean at RR or OR significance at
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
point 3
N at n at value at mean at time significance at

median at point 4
time point 2 RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
39. Comments , outcome 1
Enlarge Shrink

ARM A (control)
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
Define N at n at baseline Units value at mean at RR or OR significance at

n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
Enlarge Shrink

ARM A (control)
N at time n at time value at time baseline significance at
median at
N at time n at time value at time (specify) at time significance at Shrink
range at
point 3 point 3 point 3 point 2 time point 3
baseline
N at time n at time value at time RR or OR significance at
SD at
point 4 point 4 point 4 (specify) at time time point 4
baseline
n at point 3
final/main final/main final/main RR or OR final.main
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
Define
N randomized N at time n at time value at time baseline significance at
median at
range at
baseline
SD at
baseline
n at point 3
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
Enlarge Shrink

ARM A (control)
median at
range at
baseline
SD at
baseline
n at point 3
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
Define
median at
range at
baseline
SD at
baseline
n at point 3
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
Enlarge Shrink

ARM A (control)
median at
range at
baseline
SD at
baseline
n at point 3
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
Define
median at
range at
baseline
SD at
baseline
n at point 3
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
Enlarge Shrink

ARM A (control)
N randomized N at Units value at mean at RR or OR significance at
n at baseline
n at point 3
N at final/main value at mean at time RR or OR significance at
final/main measure final/main point 2 (specify) at time final.main

measure measure point 4 measure
median at RR or OR
time point 2 (specify) at
range at time final/main
point 2 measure
SD at time
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
n at point 3
N at final/main value at mean at time RR or OR significance at
final/main measure final/main point 2 (specify) at time final.main

measure measure point 4 measure
median at RR or OR
time point 2 (specify) at
range at time final/main
point 2 measure
SD at time
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
Enlarge Shrink

ARM A (control)
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
Define N at n at baseline Units value at mean at RR or OR significance at

n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
Enlarge Shrink

ARM A (control)
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM B
Define
median at
range at
baseline
SD at
baseline
n at point 3
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM C
Define
n at point 3
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
ARM D
Define
median at
range at
baseline
SD at
baseline
n at point 3
point 2
median at point 4
time point 2
RR or OR
point 2 final/main
SD at time measure
point 2
mean at time
point 3
median at
time point 3
range at time
point 3
SD at time
point 3
mean at time
point 4
median at
time point 4
range at time
point 4
SD at time
point 4
mean at
final/main
measure
median at
final/main
measure
range at
final/main
measure
SD at
final/main
measure
Enlarge Shrink
Form Creation Date: Mar 30 2009 8:14AM

KEY QUESTION 2
What are the barriers that clinicians, developers, and consumers and their families or caregivers encounter that limit implementation of consumer health informatics applications?
1. This study provides evidence for:
Existence of user-level barriers
Existence of systems-level barriers
Existence of other barriers (define)
User-level barrier: poor access to internet from home or community, lack of knowledge, poor literacy, culture, language, and other things which are not amenable to systems level solutions.
Systems-level barrier: design is not user-centered, poor workflow, incompatible with existing healthcare information management systems, no reimbursement for other actors, poor accessibility for
patients.
Condition of interest Barriers considered by authors (as described Barriers reported by authors as important How were the barriers data collected? Results
in the purpose or methods) (these may differ from previous column) (free
text
field)
Alcohol abuse Application usability Application usability Empirical

(user friendliness) (user friendliness) based on trial data
Asthma (e.g., log ins, #
Care giver Care giver completed Enlarge
Breast cancer preferences (define) preferences (define) modules) Shrink
Cancer, other CHI application not CHI application not Validated

than breast (specify) designed for general use designed for general use survey (e.g.,
(only designed for the (only designed for the patient or
Depression sick) sick) caregiver report,
scales of skills or
Diabetes CHI application not CHI application not other
designed for general use designed for general use characteristics)
Eating disorder (only designed for the (only designed for the
healthy) healthy) Non-validated
Headache
survey
CHI application use CHI application use
HIV/AIDS too time consuming too time consuming Observational
(e.g.,
Hypertension Confidentiality/privacy Confidentiality/privacy adminstrative
Menopaus/HRT data, review of
Control of information Control of information cost, objective
(specify) (trust) (trust) testing of usability,
Mental health objective testing of
Cost (patient) Cost (patient)
access)
(specify)
Cultural Cultural Biologic
Obesity
outcome
Disability Disability
Physical
Qualitative
activity/diet (specify) Incompatibility with Incompatibility with
(e.g., focus group,
current care current care structured
Smoking/smoking
cessation interview)
Knowledge literacy Knowledge literacy
Other Other
(Care giver's lack of skill (Care giver's lack of skill
re: CHI application) re: CHI application)

Other
Knowledge literacy Knowledge literacy
(Patient 's lack of skill re: (Patient 's lack of skill re: Other
CHI application) CHI application)
Lack of insurance for Lack of insurance for

services recommended by services recommended by
CHI application CHI application
Lack of Lack of
reimbursement (provider) reimbursement (provider)
Lack of technical Lack of technical
infrastructure (home or infrastructure (home or
community) community)
Language Language
Patient preferences Patient preferences

(define) (define)
Other Other
Other Other
Other Other
7.
Comment
Enlarge Shrink
Form Creation Date: Mar 27 2009 4:46PM

QUALITY FORM
JADAD (quality of controlled trials)
1. Was the study described as randomized (this includes the use of words such as randomly, random, and
randomization)? In other words, was the allocation concealed?
Yes (go to question 2)
No (-1)
Unspecified (0)
Clear Selection
2. If the answer to question #1 was "yes," then answer the following:
Was the method used to generate the sequence of randomization described and was it appropriate? (+1)
Was the method of randomization described but inappropriate? (-1)
unspecified (0)
Clear Selection
3. Was the study described as double blind? In other words, were the outcome assessors blind in addition to the
patients?
Yes (go to question 4)
No (-1)
unspecified (0)
Clear Selection
4. If the answer to #3 is "Yes" then answer the following:
The method of double blinding was described and appropriate (+1)
the study was described as being blind, but the method of blinding was inapproriate (-1)
unspecified (0)
Clear Selection
5. Was there a description of withdrawals and dropouts?
Yes (+1)
No (-1)
Clear Selection
Form Creation Date: Apr 13 2009 12:09PM
Form Last Modified: Apr 20 2009 1:58PM

1. Does this article POTENTIALLY apply to ANY of the key questions?
Key Question 1: What evidence exists that consumer health informatics impacts: a) health care process outcomes (e.g., receiving appropriate
treatment); b) intermediate outcomes (e.g., self-management, health care knowledge), c) relationship-centered outcomes (e.g., shared decision
making), d) clinical outcomes (e.g., quality of life), or e) economic outcomes (e.g., cost, or access to care)?
Key question 2: What are the barriers that clinicians, developers, and consumers and their families and caregivers encounter that limit
implementation of consumer health informatics applications?
Yes
No
Unclear
Clear Selection
Form Last Modified: Dec 22 2008 1:10PM
Appendix F
Appendix F: List of Excluded Articles

A new strategy to empower people in Africa. World Health Andersson G, Lundstrom P, Strom L. Internet-based
97;(6):4-5 treatment of headache: does telephone contact add
No health informatics application anything?. Headache 2003;43(4):353-61
Study of a point of care device
Adler K G. Web portals in primary care: an evaluation of
patient readiness and willingness to pay for online services. Anhoj J, Nielsen L. Quantitative and qualitative usage data
J Med Internet Res 2006;8(4):e26 of an Internet-based asthma monitoring tool. J Med Internet
No health informatics application; Res 2004;6(3):e23
Health informatics application is for general Study of a point of care device
information only AND is not tailored to the individual
consumer Apkon M, Mattera J A, Lin Z et al. A randomized
outpatient trial of a decision-support information
Ahmad F, Hogg-Johnson S, Skinner H A. Assessing patient technology tool. Arch Intern Med 2005;165(20):2388-94
attitudes to computerized screening in primary care: Study of a point of care device
psychometric properties of the computerized lifestyle
assessment scale. J Med Internet Res 2008;10(2):e11 Balmford J, Borland R, Benda P. Patterns of use of an
Study of a point of care device automated interactive personalized coaching program for
smoking cessation. J Med Internet Res 2008;10(5):e54
Allenby A, Matthews J, Beresford J et al. The application Not a RCT, and not a study addressing barriers;
of computer touch-screen technology in screening for Other*
psychosocial distress in an ambulatory oncology setting.
Eur J Cancer Care (Engl) 2002;11(4):245-53 Bandy M. Health information for patients and consumers.:
No health informatics application; Health information for patients and consumers.. 2000;325-
Study of a point of care device 350
No health informatics application;
An J. Correlates and predictors of consumers' health Health informatics application does not apply to the
information and services usage behavior on the Internet: A consumer;
structural equation modeling approach. New York Health informatics application is for general
University, 2005. (Doctoral dissertation) information only AND is not tailored to the individual
No original data; consumer
Other*
Barnason S, Zimmerman L, Nieveen J et al. Impact of a
An L C, Schillo B A, Saul J E et al. Utilization of smoking home communication intervention for coronary artery
cessation informational, interactive, and online community bypass graft patients with ischemic heart failure on self-
resources as predictors of abstinence: cohort study. J Med efficacy, coronary disease risk factor modification, and
Internet Res 2008;10(5):e55 functioning. Heart Lung 2003;32(3):147-58
Not a RCT and not a study addressing barriers No health informatics application;
Anderson PF, Wilson B. Rapid development of a
craniofacial consumer health Web site: part one, what Barrera M, Glasgow R E, McKay H G et al. Do Internet-
happens before content and coding.. Journal of Consumer based support interventions change perceptions of social
Health on the Internet 2007;11(2):13-31 support?: An experimental trial of approaches for
Health informatics application is for general supporting diabetes self-management. Am J Community
information only AND is not tailored to the individual Psychol 2002;30(5):637-54
consumer; Health informatics application is for general
No original data information only AND is not tailored to the individual
consumer;
Andersson G, Bergstrom J, Hollandare F et al. Internet- Study of a point of care device
based self-help for depression: randomised controlled trial.
Br J Psychiatry 2005;187456-61 Barry K L, Fleming M F. Computerized administration of
Study of a point of care device alcoholism screening tests in a primary care setting. J Am
Board Fam Pract 90;3(2):93-8
Other*
F-1
*Please see a list of other reasons at the end of this document


Not a RCT, and not a study addressing barriers
Bechtel-Blackwell D A. Computer-assisted self-interview
and nutrition education in pregnant teens. Clin Nurs Res Borbolla D, Giunta D, Figar S et al. Effectiveness of a
2002;11(4):450-62 chronic disease surveillance systems for blood pressure
Health informatics application is for general monitoring. Stud Health Technol Inform 2007;129(Pt
information only AND is not tailored to the individual 1):223-7
consumer No health informatics application
Berman R L, Iris M A, Bode R et al. The effectiveness of consumer
an online mind-body intervention for older adults with
chronic pain. J Pain 2009;10(1):68-79 Borckardt J J, Younger J, Winkel J et al. The computer-
Other* assisted cognitive/imagery system for use in the
management of pain. Pain Res Manag 2004;9(3):157-62
Bernhardt J M, Lariscy R A W, Parrott R L et al. Perceived Health informatics application does not apply to the
barriers to internet-based health communication on human consumer
genetics. 2002;7(4):325-340
Other* Borland R, Balmford J, Hunt D. The effectiveness of
personally tailored computer-generated advice letters for
Bexelius C, Honeth L, Ekman A et al. Evaluation of an smoking cessation. Addiction 2004;99(3):369-77
internet-based hearing test--comparison with established No health informatics application
methods for detection of hearing loss. J Med Internet Res
2008;10(4):e32 Borland R, Balmford J, Segan C et al. The effectiveness of
Not a RCT, and not a study addressing barriers; personalized smoking cessation strategies for callers to a
Other* Quitline service. Addiction 2003;98(6):837-46
Birru M S, Monaco V M, Charles L et al. Internet usage by Study of a point of care device
low-literacy adults seeking health information: an
observational analysis. J Med Internet Res 2004;6(3):e25 Borzekowski D L, Rickert V I, VI. Urban girls, internet
Health informatics application is for general use, and accessing health information. J Pediatr Adolesc
information only AND is not tailored to the individual Gynecol 2000;13(2):94-5
consumer No health informatics application;
Other*
Blas M M, Alva I E, Cabello R et al. Internet as a tool to
access high-risk men who have sex with men from a Bosworth K, Gustafson D H. CHESS: Providing Decision
resource-constrained setting: a study from Peru. Sex Support for Reducing Health Risk Behavior and Improving
Transm Infect 2007;83(7):567-70 Access to Health Services. 91;21(3):93-104
No health informatics application Not a RCT, and not a study addressing barriers;
Health informatics application does not apply to the Other*
consumer
Bouhaddou O, Lambert J G, Miller S. Consumer health
Block G, Sternfeld B, Block C H et al. Development of informatics: knowledge engineering and evaluation studies
Alive! (A Lifestyle Intervention Via Email), and its effect of medical HouseCall. Proc AMIA Symp 98;612-6
on health-related quality of life, presenteeism, and other Not a RCT, and not a study addressing barriers;
behavioral outcomes: randomized controlled trial. J Med Other*
Internet Res 2008;10(4):e43
Other* Boukhors Y, Rabasa-Lhoret R, Langelier H et al. The use
of information technology for the management of intensive
Bonniface L, Green L. Finding a new kind of knowledge on insulin therapy in type 1 diabetes mellitus. Diabetes Metab
the HeartNET website. Health Information & Libraries 2003;29(6):619-27
Journal 2007-; 2467-76 No health informatics application
Health informatics application is for general
consumer;
F-2


Braithwaite S R, Fincham F D. A randomized clinical trial tailored feedback and iterative feedback on fat, fruit, and
of a computer based preventive intervention: replication vegetable intake. HEALTH EDUC BEHAV 1998
and extension of ePREP. J Fam Psychol 2009;23(1):32-8 Aug;25:517-31].. Evidence-Based Nursing 99;2(3):83
Other* No original data
Brennan P F. Health informatics and community health: Carlbring P, Smit F. Randomized trial of internet-delivered
support for patients as collaborators in care. Methods Inf self-help with telephone support for pathological gamblers.
Med 99;38(4-5):274-8 J Consult Clin Psychol 2008;76(6):1090-4
No original data Other*
Brug J. Dutch research into the development and impact of Carlfjord S, Nilsen P, Leijon M et al. Computerized
computer-tailored nutrition education. European Journal of lifestyle intervention in routine primary health care:
Clinical Nutrition 1999;53(SUPPL. 2): S78-82 evaluation of usage on provider and responder levels.
No original data Patient Educ Couns 2009;75(2):238-43
Other*
Bukachi F, Pakenham-Walsh N. Information technology
for health in developing countries. Chest Casper G R, Brennan P F, Burke L J et al. HeartCareII:
2007;132(5):1624-30 Patients' Use of a Home Care Web Resource. Stud Health
No health informatics application; Technol Inform 2009;146139-43
Study of a point of care device Other*
Bull S S, Phibbs S, Watson S et al. What do young adults Chan D S, Callahan C W, Hatch-Pigott V B et al. Internet-
expect when they go online? Lessons for development of based home monitoring and education of children with
an STD/HIV and pregnancy prevention website. J Med asthma is comparable to ideal office-based care: results of a
Syst 2007;31(2):149-58 1-year asthma in-home monitoring trial. Pediatrics
Health informatics application is for general 2007;119(3):569-78
information only AND is not tailored to the individual Study of a point of care device
consumer
Chandra A, Rutsohn P, Carlisle MB. Utilization of the
Campbell M K, DeVellis B M, Strecher V J et al. Internet by rural West Virginia consumers.. Journal of
Improving dietary behavior: The effectiveness of tailored Consumer Health on the Internet 2004;8(2):45-59
messages in primary care settings. American Journal of Health informatics application does not apply to the
Public Health 1994; 84(5):783-787 consumer;
No health informatics application Health informatics application is for general
Campbell M K, Tessaro I, DeVellis B et al. Effects of a consumer
tailored health promotion program for female blue-collar
workers: Health works for women. Preventive Medicine Chiang M F, Starren J. Evaluation of consumer health
2002;34(3):313-323 website accessibility by users with sensory and physical
Other* disabilities. Stud Health Technol Inform 2004;107(Pt
2):1128-32
Campbell R. Older women and the internet. J Women Health informatics application is for general
Aging 2004;16(1-2):161-74 information only AND is not tailored to the individual
No health informatics application consumer
Campbell RJ, Wabby J. The elderly and the Internet: a case Chinman M, Young A S, Schell T et al. Computer-assisted
study.. Internet Journal of Health 2003;3(1):11p self-assessment in persons with severe mental illness. J
Not a RCT, and not a study addressing barriers Clin Psychiatry 2004;65(10):1343-51
Campbell SE. Individualised computer generated nutrition Health informatics application is for general
information plus interative feedback reduced dietary fat and information only AND is not tailored to the individual
increased fruit and vegetable intake [commentary on Brug consumer
J, Glanz K, Van Assema P, et al. The impact of computer-
F-3


Cho J H, Lee H C, Lim D J et al. Mobile communication individualized menopause decision aid. Med Decis Making
using a mobile phone with a glucometer for glucose control 2007;27(5):585-98
in Type 2 patients with diabetes: as effective as an Internet- No health informatics application;
based glucose monitoring system. J Telemed Telecare Health informatics application does not apply to the
2009;15(2):77-82 consumer
Study of a point of care device Cook R F, Billings D W, Hersch R K et al. A field test of a
web-based workplace health promotion program to
Christensen H, Griffiths K, Groves C et al. Free range users improve dietary practices, reduce stress, and increase
and one hit wonders: Community users of an internet-based physical activity: Randomized controlled trial. Journal of
cognitive behaviour therapy program. Australian and New Medical Internet Research 2007;9:e17
Zealand Journal of Psychiatry 2006;40(1):59-62 Other*
Cox A, Boehm M, Summers R et al. Patient perspective.
Cintron A, Phillips R, Hamel M B. The effect of a web- Using a virtual community to support healthcare. Quality in
based, patient-directed intervention on knowledge, Primary Care 2003;11(2):143-145
discussion, and completion of a health care proxy. J Palliat Health informatics application is for general
Med 2006;9(6):1320-8 information only AND is not tailored to the individual
Health informatics application is for general consumer;
information only AND is not tailored to the individual No original data
consumer
Cummings E, Turner P. Patient self-management and
Civan A, Skeels M M, Stolyar A et al. Personal health chronic illness: evaluating outcomes and impacts of
information management: consumers' perspectives. AMIA information technology. Stud Health Technol Inform
Annu Symp Proc 2006;156-60 2009;143229-34
Other* No health informatics application;
Clarke G, Eubanks D, Reid E et al. Overcoming Depression
on the Internet (ODIN) (2): a randomized trial of a self-help Cummings E, Turner P. Patient self-management and
depression skills program with reminders. J Med Internet chronic illness: evaluating outcomes and impacts of
Res 2005;7(2):e16 information technology. Stud Health Technol Inform
Study of a point of care device 2009;143229-34
Other*
Clayton A E, McNutt L A, Homestead H L et al. Public
health in managed care: a randomized controlled trial of the Cunningham J A, Humphreys K, Koski-Jannes A.
effectiveness of postcard reminders. Am J Public Health Providing personalized assessment feedback for problem
99;89(8):1235-7 drinking on the internet: A pilot project. 2000;61(6):794-
No health informatics application 798
Not a RCT and not a study addressing barriers;
Cobb N K, Graham A L, Bock B C et al. Initial evaluation Other*
of a real-world internet smoking cessation system. Nicotine
Tob Res. 2005;7(2):207-216 Cunningham J A, Selby P, van Mierlo T. Integrated online
Not a RCT, and not a study addressing barriers services for smokers and drinkers? Use of the check your
drinking assessment screener by participants of the Stop
Coile R C. E-health: Reinventing healthcare in the Smoking Center. Nicotine Tob Res 2006;8 Suppl 1S21-5
information age. Journal of Healthcare Management. No health informatics application;
2000;45(3):206-210 Study of a point of care device
Curioso W H, Kurth A E. Access, use and perceptions
Col N F, Ngo L, Fortin J M et al. Can computerized regarding Internet, cell phones and PDAs as a means for
decision support help patients make complex treatment health promotion for people living with HIV in Peru. BMC
decisions? A randomized controlled trial of an Med Inform Decis Mak 2007;724
F-4


information only AND is not tailored to the individual De Bourdeaudhuij I, Stevens V, Vandelanotte C et al.
consumer Evaluation of an interactive computer-tailored nutrition
intervention in a real-life setting. Annals of Behavioral
Curioso W H, Kurth A E. Access, use and perceptions Medicine 2007;33(1):39-48
regarding Internet, cell phones and PDAs as a means for Other*
health promotion for people living with HIV in Peru. BMC
Med Inform Decis Mak 2007;724 Demiris G, Finkelstein S M, Speedie S M. Considerations
Other* for the design of a Web-based clinical monitoring and
educational system for elderly patients. Journal of the
Damster G, Williams J R. The Internet, virtual American Medical Informatics Association 2001;8(5):468-
communities and threats to confidentiality. S Afr Med J 472
99;89(11):1175-8 No original data
information only AND is not tailored to the individual Demiris G, Rantz M, Aud M et al. Older adults' attitudes
consumer; towards and perceptions of "smart home" technologies: a
No original data pilot study. Med Inform Internet Med 2004;29(2):87-94
Danaher B G, Boles S M, Akers L et al. Defining Health informatics application does not apply to the
participant exposure measures in Web-based health consumer
behavior change programs. J Med Internet Res
2006;8(3):e15 Detailed report on physician and patient use of the Web.
No health informatics application; Internet Healthc Strateg 2003;5(5):5-6
Other* Health informatics application is for general
Dart J, Gallois C, Yellowlees P. Community health consumer;
information sources--a survey in three disparate No original data
communities. Aust Health Rev 2008;32(1):186-96
Health informatics application is for general Dilts D, Ridner S H, Franco A et al. Patients with cancer
information only AND is not tailored to the individual and e-mail: implications for clinical communication.
consumer Support Care Cancer 2008;
Dart J. The internet as a source of health information in information only AND is not tailored to the individual
three disparate communities. Aust Health Rev consumer
2008;32(3):559-69
Health informatics application is for general Dimeff L A, McNeely M. Computer-enhanced primary
information only AND is not tailored to the individual care practitioner advice for high-risk college drinkers in a
consumer student primary health-care setting. Cognitive and
Behavioral Practice 2000;7(1):82-100
Davison B J, Degner L F. Feasibility of using a computer- Not a RCT, and not a study addressing barriers;
assisted intervention to enhance the way women with breast Other*
cancer communicate with their physicians. Cancer Nurs
2002;25(6):417-24 Dini E F, Linkins R W, Sigafoos J. The impact of
Other* computer-generated messages on childhood immunization
coverage. Am J Prev Med 2000;18(2):132-9
Dawson A J, Konkin D, Riordan D et al. Education about Health informatics application does not apply to the
genetic testing for breast cancer susceptibility: Patient consumer;
preferences for a computer program or genetic counselor. Study of a point of care device
American Journal of Medical Genetics 2001;103(1):24-31
Health informatics application is for general Dolezal-Wood S, Belar C D, Snibbe J. A Comparison of
information only AND is not tailored to the individual Computer-Assisted Psychotherapy and Cognitive-
consumer; Behavioral Therapy in Groups. Journal of Clinical
Not a RCT, and not a study addressing barriers Psychology in Medical Settings 98;5(1):103-115
F-5


Other* Other*
Doumas D M, McKinley L L, Book P. Evaluation of two Etter J F, Perneger T V. Post-intervention effect of a

Web-based alcohol interventions for mandated college computer tailored smoking cessation programme. J
students. J Subst Abuse Treat 2009;36(1):65-74 Epidemiol Community Health 2004;58(10):849-51
Other*
Draper S, Coffman S. Logging on: what it takes to provide
patients with computer access. Biomed Instrum Technol Eysenbach G. From intermediation to disintermediation
2004-2005;Suppl17-9 and apomediation: new models for consumers to access and
No original data assess the credibility of health information in the age of
Dreault RT. Information anxiety. Mississippi RN Web2.0. Stud Health Technol Inform 2007;129(Pt 1):162-6
2000;62(3):11-14 No health informatics application;
No health informatics application Study of a point of care device
Edwards A, Thomas R, Williams R et al. Presenting risk Feldstein A C, Smith D H, Perrin N et al. Improved
information to people with diabetes: evaluating effects and therapeutic monitoring with several interventions: a
preferences for different formats by a web-based randomized trial. Arch Intern Med 2006;166(17):1848-54
randomised controlled trial. Patient Educ Couns No health informatics application
2006;63(3):336-49
Health informatics application is for general Ferrer-Roca O, C+írdenas A, Diaz-Cardama A et al.
information only AND is not tailored to the individual Mobile phone text messaging in the management of
consumer diabetes. Journal of Telemedicine and Telecare
2004;10(5):282-285
Ellison G L, Weinrich S P, Lou M et al. A randomized trial Other*
comparing web-based decision aids on prostate cancer
knowledge for African-American men. J Natl Med Assoc Ferriman A. Patients get access to evidence based, online
2008;100(10):1139-45 health information. BMJ 2002;325(7365):618
Not a RCT, and not a study addressing barriers No original data
Emmons K M, Wong M, Puleo E et al. Tailored computer- Finfgeld-Connett D, Madsen R. Web-based treatment of
based cancer risk communication: Correcting colorectal alcohol problems among rural women. J Psychosoc Nurs
cancer risk perception. Journal of Health Communication Ment Health Serv 2008;46(9):46-53
2004;9(2):127-141 Health informatics application does not apply to the
Other* consumer;
Other*
Enterprise scheduling may improve patient access.
''Transparent'' registration is the goal. Patient Focus Care Fitzgibbon M L, Stolley M R, Schiffer L et al. Two-year
Satisf 98;6(7):83-6 follow-up results for Hip-Hop to Health Jr.: A randomized
No health informatics application; controlled trial for overweight prevention in preschool
Health informatics application is for general minority children. Journal of Pediatrics 2005;146(5):618-
information only AND is not tailored to the individual 625
consumer No health informatics application
Ervin N E, Berry M M. Community readiness for a Ford P. Brief report. Is the Internet changing the
computer-based health information network. J N Y State relationship between consumers and practitioners? Journal
Nurses Assoc 2006;37(1):5-11 for Healthcare Quality: Promoting Excellence in Healthcare
No health informatics application 2000;22(5):41-43
Escoffery C, McCormick L, Bateman K. Development and Health informatics application is for general
process evaluation of a web-based smoking cessation information only AND is not tailored to the individual
program for college smokers: innovative tool for education. consumer
Patient Educ Couns 2004;53(2):217-25
F-6


Franklin V L, Greene A, Waller A et al. Patients' No health informatics application;
engagement with "Sweet Talk" - a text messaging support Health informatics application does not apply to the
system for young people with diabetes. J Med Internet Res consumer
2008;10(2):e20
No health informatics application; Graham W, Smith P, Kamal A et al. Randomised controlled
Other* trial comparing effectiveness of touch screen system with
leaflet for providing women with information on prenatal
Friedman D B, Kao E K. A comprehensive assessment of tests. BMJ 2000;320(7228):155-160
the difficulty level and cultural sensitivity of online cancer No health informatics application;
prevention resources for older minority men. Prev Chronic Health informatics application is for general
Dis 2008;5(1):A07 information only AND is not tailored to the individual
No health informatics application; consumer
information only AND is not tailored to the individual Gruber K, Moran P J, Roth W T et al. Computer-Assisted
consumer Cognitive Behavioral Group Therapy for Social Phobia.
Behavior Therapy 2001;32(1):155-165
Fung V, Ortiz E, Huang J et al. Early experiences with e- Study of a point of care device;
health services (1999-2002): promise, reality, and Not a RCT, and not a study addressing barriers
implications. Med Care 2006;44(5):491-6
Study of a point of care device Gustafson D H, Bosworth K, Chewning B et al. Computer-
based health promotion: combining technological advances
Garth McKay H, Glasgow R E, Feil E G et al. Internet- with problem-solving techniques to effect successful health
based diabetes self-management and support: Initial behavior changes. Annual Review of Public health 87
outcomes from the diabetes network project. Rehabilitation ;(8)387-415
Psychology 2002;47(1):31-48 No original data
Health informatics application does not apply to the Gustafson D H, Hawkins R P, Boberg E W et al. CHESS:
consumer ten years of research and development in consumer health
informatics for broad populations, including the
Gerressu M, French R S. Using the Internet to promote underserved. Stud Health Technol Inform 2001;84(Pt
sexual health awareness among young people. J Fam Plann 2):1459-563
Reprod Health Care 2005;31(4):267, 269-70 No original data
No original data
Gustafson D H, McTavish F M, Boberg E et al.
Glasgow R E, Barrera M, Mckay H G et al. Social support, Empowering patients using computer based health support
self-management, and quality of life among participants in systems. Quality in Health Care 99;8(1):49-56
an Internet-based diabetes support program: A multi- No original data
dimensional investigation. Cyberpsychology and Behavior
99;2(4):271-281 Gustafson D H, McTavish F M, Stengle W et al. Reducing
Not a RCT, and not a study addressing barriers; the digital divide for low-income women with breast
Other* cancer: a feasibility study of a population-based
intervention. J Health Commun 2005;10 Suppl 1173-93
Goulis D G, Giaglis G D, Boren S A et al. Effectiveness of Study of a point of care device
home-centered care through telemedicine applications for
overweight and obese patients: a randomized controlled Gustafson D H, McTavish F M, Stengle W et al. Use and
trial. Int J Obes Relat Metab Disord 2004;28(11):1391-8 Impact of eHealth System by Low-income Women With
Study of a point of care device; Breast Cancer. J Health Commun 2005;10 Suppl 1195-218
Other* Not a RCT, and not a study addressing barriers
Graham A L, Bock B C, Cobb N K et al. Characteristics of Gustafson D H, Robinson T N, Ansley D et al. Consumers
smokers reached and recruited to an internet smoking and evaluation of interactive health communication
cessation trial: a case of denominators. Nicotine Tob Res applications. American Journal of Preventive Medicine
2006;8 Suppl 1S43-8 99;16(1):23-29
F-7


Health informatics application is for general Hayashi A, Kayama M, Ando K et al. Analysis of
information only AND is not tailored to the individual subjective evaluations of the functions of tele-coaching
consumer; intervention in patients with spinocerebellar degeneration.
No original data NeuroRehabilitation 2008;23(2):159-69
Gutteling J J, Busschbach J J, de Man R A et al. Logistic consumer;
feasibility of health related quality of life measurement in Study of a point of care device
clinical practice: results of a prospective study in a large
population of chronic liver patients. Health Qual Life Heidenreich P A, Chacko M, Goldstein M K et al. ACE
Outcomes 2008;6(1):97 inhibitor reminders attached to echocardiography reports of
Health informatics application does not apply to the patients with reduced left ventricular ejection fraction. Am
consumer J Med 2005;118(9):1034-7
Haerens L, Deforche B, Maes L et al. Evaluation of a 2-
year physical activity and healthy eating intervention in Hibbard J H, Peters E, Dixon A et al. Consumer
middle school children. Health Education Research competencies and the use of comparative quality
2006;21(6):911-921 information: it isn't just about literacy. Med Care Res Rev
No health informatics application 2007;64(4):379-94
Hanauer D, Dibble E, Fortin J et al. Internet use among Health informatics application does not apply to the
community college students: implications in designing consumer
healthcare interventions. J Am Coll Health 2004;52(5):197-
202 Hill W, Weinert C, Cudney S. Influence of a computer
No health informatics application; intervention on the psychological status of chronically ill
Health informatics application is for general rural women: preliminary results. Nurs Res 2006;55(1):34-
information only AND is not tailored to the individual 42
consumer Health informatics application is for general
Hartmann C W, Sciamanna C N, Blanch D C et al. A consumer;
website to improve asthma care by suggesting patient Study of a point of care device
questions for physicians: qualitative analysis of user
experiences. J Med Internet Res 2007;9(1):e3 Holmes-Rovner M, Stableford S, Fagerlin A et al.
Other* Evidence-based patient choice: a prostate cancer decision
aid in plain language. BMC Med Inform Decis Mak
Harvey K, Churchill D, Crawford P et al. Health 2005;516
communication and adolescents: what do their emails tell No health informatics application
us?. Fam Pract 2008;25(4):304-11
No health informatics application Hopper K D, Zajdel M, Hulse S F et al. Interactive method
of informing patients of the risks of intravenous contrast
Harvey-Berino J, Pintauro S, Buzzell P et al. Does using media. Radiology 94;192(1):67-71
the Internet facilitate the maintenance of weight loss? Health informatics application does not apply to the
International Journal of Obesity 2002;26(9):1254-1260 consumer;
Not a RCT and not a study addressing barriers; Other*
Other*
Huber J T, Huggins D W. Assessing electronic information
Harvey-Berino J, Pintauro S, Buzzell P et al. Effect of access and use in long-term care facilities in north Texas.
internet support on the long-term maintenance of weight Bull Med Libr Assoc 2000;88(2):187-9
loss. Obes Res 2004;12(2):320-9 Health informatics application does not apply to the
Health informatics application is for general consumer
consumer; Hughes S, Dennison C R. Progress in prevention: how can
Study of a point of care device we help patients seek information on the World Wide
F-8


Web?: an opportunity to improve the "net effect". J No health informatics application;
Cardiovasc Nurs 2008;23(4):324-5 Other*
information only AND is not tailored to the individual Jones J. Patient education and the use of the World Wide
consumer; Web. Clin Nurse Spec 2003;17(6):281-3
No original data Health informatics application is for general
Hung S H, Hwang S L, Su M J et al. An evaluation of a consumer;
weight-loss program incorporating E-learning for obese No original data
junior high school students. Telemed J E Health
2008;14(8):783-92 Jones R B, Atkinson J M, Coia D A et al. Randomised trial
Not a RCT, and not a study addressing barriers of personalised computer based information for patients
with schizophrenia. BMJ 2001;322(7290):835-40
Huss K, Salerno M, Huss R W. Computer-assisted Health informatics application does not apply to the
reinforcement of instruction: effects on adherence in adult consumer
atopic asthmatics. Research in nursing & health
91;14(4):259-267 Jones R, Labajo R, Soler-Lopez Alonso et al. "Evaluation
Health informatics application is for general of a Scottish touch-screen public-access health information
information only AND is not tailored to the individual system in rural Spain." In Current Perspectives in
consumer Healthcare Computing Conference, Harrogate 20-22 March
2000, 45-54. Guildford, UNITED KINGDOM: British
Irvine A B, Ary D V, Grove D A et al. The effectiveness of Computer Society Health Informatics Committee, 2000
an interactive multimedia program to influence eating Health informatics application is for general
habits. Health Education Research 2004;19(3):290-305 information only AND is not tailored to the individual
No health informatics application consumer
Izenberg N, Lieberman D A. The Web, communication Jones R, Pearson J, Cawsey A et al. Information for
trends, and children's health. Part 3: The Web and health patients with cancer. Does personalization make a
consumers. Clin Pediatr (Phila) 98;37(5):275-85 difference? Pilot study results and randomised trial in
No original data progress. Proc AMIA Annu Fall Symp 96;423-7
No original data;
Jackson S J. Access to medical information: essential for Not a RCT and not a study addressing barriers
better patient care. J Tenn Med Assoc 72;65(10):902-6
Health informatics application is for general Kaldo V, Levin S, Widarsson J et al. Internet versus group
information only AND is not tailored to the individual cognitive-behavioral treatment of distress associated with
consumer tinnitus: a randomized controlled trial. Behav Ther
2008;39(4):348-59
Jacobs A D, Ammerman A S, Ennett S T et al. Effects of a Health informatics application does not apply to the
tailored follow-up intervention on health behaviors, beliefs, consumer;
and attitudes. Journal of Women’s Health 2004;13(5):557- Study of a point of care device
568
Study of a point of care device Kaphingst K A, Zanfini C J, Emmons K M. Accessibility
of web sites containing colorectal cancer information to
Jansa M, Vidal M, Viaplana J et al. Telecare in a structured adults with limited literacy (United States). Cancer Causes
therapeutic education programme addressed to patients Control 2006;17(2):147-51
with type 1 diabetes and poor metabolic control. Diabetes Health informatics application is for general
Res Clin Pract 2006;74(1):26-32 information only AND is not tailored to the individual
Study of a point of care device consumer
Jibaja-Weiss M L, Volk R J. Utilizing computerized Kaufman DR, Rockoff ML. Increasing access to online
entertainment education in the development of decision information about health: a program for inner-city elders in
aids for lower literate and naive computer users. J Health community-based organizations. Generations
Commun 2007;12(7):681-97 2006;30(2):55-57
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Kennedy M G, Kiken L, Shipman J P. Addressing consumer
underutilization of consumer health information resource
centers: a formative study. J Med Libr Assoc Kim S, Chung D S. Characteristics of cancer blog users. J
2008;96(1):42-9 Med Libr Assoc 2007;95(4):445-50
No health informatics application; Health informatics application does not apply to the
Health informatics application is for general consumer;
information only AND is not tailored to the individual Health informatics application is for general
consumer information only AND is not tailored to the individual
consumer
Kenwright M, Liness S, Marks I. Reducing demands on
clinicians by offering computer-aided self-help for King A C, Friedman R, Marcus B et al. Ongoing Physical
phobia/panic. Feasibility study. Br J Psychiatry Activity Advice by Humans Versus Computers: The
2001;179456-9 Community Health Advice by Telephone (CHAT) Trial.
Study of a point of care device; Health Psychol. 2007;26(6):718-727
Not a RCT, and not a study addressing barriers Other*
Kerr C, Murray E, Stevenson F et al. Interactive health Kingston J. Web-based support for patients with type 2
communication applications for chronic disease: patient diabetes in West Norfolk Primary Care Trust. A district
and carer perspectives. J Telemed Telecare 2005;11 Suppl model of diabetes care. Practical Diabetes International
132-4 2005;22(8):302
No health informatics application; No original data
information only AND is not tailored to the individual Kiropoulos L A, Klein B, Austin D W et al. Is internet-
consumer based CBT for panic disorder and agoraphobia as effective
as face-to-face CBT?. J Anxiety Disord 2008;22(8):1273-
Khoo K, Bolt P, Babl F E et al. Health information seeking 84
by parents in the Internet age. J Paediatr Child Health Study of a point of care device;
2008;44(7-8):419-23 Other*
consumer Kiss G R, Walton H J, Farvis K M et al. An adaptive, on-
line computer program for the exploration of attitude
Kim E H, Stolyar A, Lober W B et al. Usage patterns of a structures in psychiatric patients. Int J Biomed Comput
personal health record by elderly and disabled users. AMIA 74;5(1):39-50
Annu Symp Proc 2007;409-13 Study of a point of care device
consumer Klein B, Richards J C, Austin D W. Efficacy of internet
therapy for panic disorder. J Behav Ther Exp Psychiatry
Kim H S, Yoo Y S, Shim H S. Effects of an Internet-based 2006;37(3):213-38
intervention on plasma glucose levels in patients with type Study of a point of care device
2 diabetes. J Nurs Care Qual 2005;20(4):335-40
Health informatics application does not apply to the Koivunen M, Hatonen H, Valimaki M. Barriers and
consumer; facilitators influencing the implementation of an interactive
Study of a point of care device Internet-portal application for patient education in
psychiatric hospitals. Patient Educ Couns 2008;70(3):412-9
Kim J, Trace D, Meyers K et al. An empirical study of the Health informatics application does not apply to the
Health Status Questionnaire System for use in patient- consumer
computer interaction. Proc AMIA Annu Fall Symp 97;86-
90 Koonce T Y, Giuse D A, Beauregard J M et al. Toward a
Health informatics application does not apply to the more informed patient: bridging health care information
consumer; through an interactive communication portal. J Med Libr
Assoc 2007;95(1):77-81
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Health informatics application is for general Lemire M, Pare G, Sicotte C et al. Determinants of Internet
information only AND is not tailored to the individual use as a preferred source of information on personal health.
consumer; Int J Med Inform 2008;77(11):723-34
No original data No health informatics application;
Kreuter M W, Strecher V J. Do tailored behavior change information only AND is not tailored to the individual
messages enhance the effectiveness of health risk consumer
appraisal? Results from a randomized trial. Health
Education Research 96;11(1):97-105 Lemire M, Pare G, Sicotte C et al. Determinants of Internet
No health informatics application use as a preferred source of information on personal health.
Int J Med Inform 2008;77(11):723-34
Krukowski R A, Harvey-Berino J, Ashikaga T et al. No original data
Internet-based weight control: the relationship between web
features and weight loss. Telemed J E Health Leong T Y, Aronsky D, Shabot M M. Computer-based
2008;14(8):775-82 decision support for critical and emergency care. J Biomed
Other* Inform 2008;41(3):409-12
No original data
Kypri K, Langley J D, Saunders J B et al. Randomized
controlled trial of web-based alcohol screening and brief Leung K Y, Lee C P, Chan H Y et al. Randomised trial
intervention in primary care. Arch Intern Med comparing an interactive multimedia decision aid with a
2008;168(5):530-6 leaflet and a video to give information about prenatal
Health informatics application does not apply to the screening for Down syndrome. Prenat Diagn
consumer 2004;24(8):613-8
Lai T Y, Larson E L, Rockoff M L et al. User acceptance of consumer
HIV TIDES--Tailored Interventions for Management of
Depressive Symptoms in persons living with HIV/AIDS. J Levetan C S, Dawn K R, Robbins D C et al. Impact of
Am Med Inform Assoc 2008;15(2):217-26 computer-generated personalized goals on HbA(1c).
Not a RCT, and not a study addressing barriers Diabetes care 2002;25(1):2-8
Other*
Lange A, van de, Ven J P et al. Interapy, treatment of
posttraumatic stress through the Internet: a controlled trial. Lewis D, Gunawardena S, El Saadawi G. Caring
J Behav Ther Exp Psychiatry 2001;32(2):73-90 connection: developing an Internet resource for family
Study of a point of care device caregivers of children with cancer. Comput Inform Nurs
2005;23(5):265-74
Lee C J. Does the internet displace health professionals?. J Health informatics application is for general
Health Commun 2008;13(5):450-64 information only AND is not tailored to the individual
Health informatics application does not apply to the consumer;
consumer No original data
Lee D M, Fairley C K, Sze J K et al. Access to sexual Liaw S T, Radford A J, Maddocks I. The impact of a
health advice using an automated, internet-based risk computer generated patient held health record. Aust Fam
assessment service. Sex Health 2009;6(1):63-6 Physician 98;27 Suppl 1S39-43
Other* Health informatics application does not apply to the
consumer;
Legare F, Dodin S, Stacey D et al. Patient decision aid on Not a RCT, and not a study addressing barriers
natural health products for menopausal symptoms:
randomized controlled trial. Menopause Int Lim J E, Choi O H, Na H S et al. A context-aware fitness
2008;14(3):105-10 guide system for exercise optimization in U-health. IEEE
No health informatics application Trans Inf Technol Biomed 2009;13(3):370-9
consumer;
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Lim J E, Choi O H, Na H S et al. A context-aware fitness Magee J C, Ritterband L M, Thorndike F P et al. Exploring
guide system for exercise optimization in U-health. IEEE the Relationship between Parental Worry about their
Trans Inf Technol Biomed 2009;13(3):370-9 Children's Health and Usage of an Internet Intervention for
Other* Pediatric Encopresis. J Pediatr Psychol 2008;
Lindsay S, Smith S, Bellaby P et al. The health impact of consumer;
an online heart disease support group: a comparison of Other*
moderated versus unmoderated support. Health Educ Res
2009;24(4):646-54 Mahabee-Gittens E M, Gordon J S, Krugh M E et al. A
No health informatics application; smoking cessation intervention plus proactive quitline
Health informatics application is for general referral in the pediatric emergency department: a pilot
information only AND is not tailored to the individual study. Nicotine Tob Res 2008;10(12):1745-51
consumer; No health informatics application;
Linke S, Brown A, Wallace P. Down your drink: A web- consumer
based intervention for people with excessive alcohol
consumption. Alcohol and Alcoholism 2004;39(1):29-32 Majumdar BB. The effectiveness of a culturally sensitive
Not a RCT, and not a study addressing barriers educational programme of self-perception of health,
happiness, self-confidence, and loneliness in Southeast
Linke S, Murray E, Butler C et al. Internet-based Asian seniors. 1995 (Doctoral Dissertation)
interactive health intervention for the promotion of sensible Other*
drinking: Patterns of use and potential impact on members
of the general public. Journal of Medical Internet Research Malone M, Mathes L, Dooley J et al. Health information
2007;9: e10 seeking and its effect on the doctor-patient digital divide. J
Not a RCT, and not a study addressing barriers Telemed Telecare 2005;11 Suppl 125-8
Lipkus I M, Rimer B K, Halabi S et al. Can tailored
interventions increase mammography use among HMO Marceau L D, Link C, Jamison R N et al. Electronic diaries
women?. Am J Prev Med 2000;18(1):1-10 as a tool to improve pain management: is there any
No health informatics application evidence?. Pain Med 2007;8 Suppl 3S101-9
Lorence D P, Greenberg L. The zeitgeist of online health information only AND is not tailored to the individual
search. Implications for a consumer-centric health system. J consumer
Gen Intern Med 2006;21(2):134-9
No health informatics application; Marcus B H, Lewis B A, Williams D M et al. Step into
Health informatics application is for general Motion: a randomized trial examining the relative efficacy
information only AND is not tailored to the individual of Internet vs. print-based physical activity interventions.
consumer Contemp Clin Trials 2007;28(6):737-47
Other*
Lorence D, Park H. Group disparities and health
information: a study of online access for the underserved. Masucci M M, Homko C, Santamore W P et al.
Health Informatics J 2008;14(1):29-38 Cardiovascular disease prevention for underserved patients
Health informatics application is for general using the Internet: bridging the digital divide. Telemed J E
information only AND is not tailored to the individual Health 2006;12(1):58-65
consumer Study of a point of care device
Macdougall J. Community access to health information in Matano R A, Koopman C, Wanat S F et al. A pilot study of
Ireland. Health Libr Rev 99;16(2):89-96 an interactive web site in the workplace for reducing
No health informatics application; alcohol consumption. J Subst Abuse Treat 2007;32(1):71-
Health informatics application does not apply to the 80
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Other* Meingast M, Roosta T, Sastry S. Security and privacy
issues with health care information technology. Conf Proc
Mattila E, Parkka J, Hermersdorf M et al. Mobile diary for IEEE Eng Med Biol Soc 2006;15453-8
wellness management--results on usage and usability in No health informatics application
two user studies. IEEE Trans Inf Technol Biomed Health informatics application does not apply to the
2008;12(4):501-12 consumer
No original data
Mennell S, Murcott A, van Otterloo A H. The sociology of
Mayben J K, Giordano T P. Internet use among low- food: eating, diet and culture. Sociology Abstracts 1992;
income persons recently diagnosed with HIV infection. Newbury Park, CA: Sage Publications
AIDS Care 2007;19(9):1182-7 Other*
consumer; Mermelstein R, Turner L. Web-based support as an adjunct
Health informatics application is for general to group-based smoking cessation for adolescents. Nicotine
information only AND is not tailored to the individual Tob Res 2006;8 Suppl 1S69-76
consumer Health informatics application does not apply to the
consumer;
McClure L A, Harrington K F, Graham H et al. Internet- Study of a point of care device
based monitoring of asthma symptoms, peak flow meter
readings, and absence data in a school-based clinical trial. Mitchell J E, Myers T, Swan-Kremeier L et al.
Clinical Trials 2008;5(1):31-37 Psychotherapy for bulimia nervosa delivered via
Health informatics application does not apply to the telemedicine. European Eating Disorders Review
consumer 2003;11(3):222-230
Study of a point of care device;
McCoy M R, Couch D, Duncan N D et al. Evaluating an Other*
Internet weight loss program for diabetes prevention.
Health Promotion International 2005;20(3):221-228 Molenaar S, Sprangers M A, Postma-Schuit F C et al.
Not a RCT, and not a study addressing barriers; Feasibility and effects of decision aids. Med Decis Making
Other* 2000;20(1):112-27
No original data
McKee B. Electronic access to consumer health
information.. Health Libraries Review 89;6(2):119-121 Montani S, Bellazzi R, Quaglini S et al. Meta-analysis of
No original data the effect of the use of computer-based systems on the
metabolic control of patients with diabetes mellitus.
McMahon G T, Gomes H E, Hickson Hohne S et al. Web- Diabetes Technology and Therapeutics 2001;3(3):347-356
based care management in patients with poorly controlled No original data
diabetes. Diabetes Care 2005;28(7):1624-9
Health informatics application does not apply to the Montelius E, Astrand B, Hovstadius B et al. Individuals
consumer; appreciate having their medication record on the web: a
Study of a point of care device survey of attitudes to a national pharmacy register. J Med
Internet Res 2008;10(4):e35
McTavish F M, Pingree S, Hawkins R et al. Cultural Health informatics application does not apply to the
differences in use of an electronic discussion group. Journal consumer;
of Health Psychology 2003;8(1):105-117 Health informatics application is for general
Other* information only AND is not tailored to the individual
consumer
Mead N, Varnam R, Rogers A et al. What predicts patients'
interest in the Internet as a health resource in primary care Moore T J, Alsabeeh N, Apovian C M et al. Weight, blood
in England?. J Health Serv Res Policy 2003;8(1):33-9 pressure, and dietary benefits after 12 months of a Web-
Health informatics application is for general based Nutrition Education Program (DASH for health):
information only AND is not tailored to the individual longitudinal observational study. J Med Internet Res
consumer 2008;10(4):e52
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Health informatics application is for general No original data
consumer; Norman C. CATCH-IT Report: Evaluation of an Internet-
Not a RCT, and not a study addressing barriers based smoking cessation program: Lessons learned from a
pilot study. Journal of Medical Internet Research 2004;6(4)
Moore T J, Alsabeeh N, Apovian C M et al. Weight, blood No original data
pressure, and dietary benefits after 12 months of a Web-
based Nutrition Education Program (DASH for health): Nwosu CR, Cox BM. The impact of the Internet on the
longitudinal observational study. J Med Internet Res doctor-patient relationship.. Health Informatics Journal
2008;10(4):e52 2000;6(3):156-161
Other* No health informatics application
Moran W P, Nelson K, Wofford J L et al. Computer- O'Connor A M, Rostom A, Fiset V et al. Decision aids for
generated mailed reminders for influenza immunization: a patients facing health treatment or screening decisions:
clinical trial. J Gen Intern Med 92;7(5):535-7 systematic review. BMJ 99;319(7212):731-4
No health informatics application No original data;
Study of a point of care device Not a RCT, and not a study addressing barriers
Mustafa Y. E-health centre: a web-based tool to empower Oenema A, Brug J. Feedback strategies to raise awareness
patients to become proactive customers. Health Info Libr J of personal dietary intake: Results of a randomized
2004;21(2):129-33 controlled trial. Preventive Medicine 2003;36(4):429-439
Newton N C, Andrews G, Teesson M et al. Delivering Olver I N, Whitford H S, Denson L A et al. Improving
prevention for alcohol and cannabis using the internet: a informed consent to chemotherapy: a randomized
cluster randomised controlled trial. Prev Med controlled trial of written information versus an interactive
2009;48(6):579-84 multimedia CD-ROM. Patient Educ Couns 2009;74(2):197-
Health informatics application is for general 204
information only AND is not tailored to the individual Other*
consumer
Ornstein S M, Garr D R, Jenkins R G et al. Computer-
Nguyen H Q, Carrieri-Kohlman V, Rankin S H et al. Is generated physician and patient reminders. Tools to
Internet-based support for dyspnea self-management in improve population adherence to selected preventive
patients with chronic obstructive pulmonary disease services. J Fam Pract 91;32(1):82-90
possible? Results of a pilot study. Heart Lung Study of a point of care device
2005;34(1):51-62
Study of a point of care device Osman L M, Abdalla M I, Beattie J A et al. Reducing
hospital admission through computer supported education
Nix S T, Ibanez C D, Strobino B A et al. Developing a for asthma patients. Grampian Asthma Study of Integrated
computer-assisted health knowledge quiz for preschool Care (GRASSIC). BMJ 94;308(6928):568-71
children. Journal of School Health 99;69(1):9-11 No health informatics application
consumer Otsuki M. Social connectedness and smoking behaviors
among Asian American college students: An electronic
Noell J, Glasgow R E. Interactive technology applications diary study. Nicotine Tob Res 2009;11(4):418-26
for behavioral counseling: Issues and opportunities for No health informatics application;
health care settings. American Journal of Preventive Other*
Medicine 99;17(4):269-274
No original data Papadaki A, Scott J A. Follow-up of a web-based tailored
intervention promoting the Mediterranean diet in Scotland.
Norman C D, Skinner H A. eHealth Literacy: Essential Patient Educ Couns 2008;73(2):256-63
Skills for Consumer Health in a Networked World. J Med Not a RCT, and not a study addressing barriers;
Internet Res 2006;8(2):e9 Other*
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Parlove AE, Cowdery JE, Hoerauf SL. Acceptability and
appeal of a Web-based smoking prevention intervention for Plotnikoff R C, McCargar L J, Wilson P M et al. Efficacy
adolescents.. International Electronic Journal of Health of an e-mail intervention for the promotion of physical
Education 2004;71-8 activity and nutrition behavior in the workplace context.
No health informatics application; American Journal of Health Promotion 2005;19(6):422-429
Other* No health informatics application
Partin M R, Nelson D, Flood A B et al. Who uses decision Polzien K M, Jakicic J M, Tate D F et al. The efficacy of a
aids? Subgroup analyses from a randomized controlled technology-based system in a short-term behavioral weight
effectiveness trial of two prostate cancer screening decision loss intervention. Obesity (Silver Spring) 2007;15(4):825-
support interventions. Health Expect 2006;9(3):285-95 30
No health informatics application No health informatics application;
Patrick K, Raab F, Adams M A et al. A text message-based
intervention for weight loss: randomized controlled trial. J Port K, Palm K, Viigimaa M. Daily usage and efficiency of
Med Internet Res 2009;11(1):e1 remote home monitoring in hypertensive patients over a
Health informatics application is for general one-year period. J Telemed Telecare 2005;11 Suppl 134-6
information only AND is not tailored to the individual No health informatics application
consumer;
Other* Porter S C, Silvia M T, Fleisher G R et al. Parents as direct
contributors to the medical record: validation of their
Patten C A, Rock E, Meis T M et al. Frequency and type of electronic input. Ann Emerg Med 2000;35(4):346-52
use of a home-based, Internet intervention for adolescent No health informatics application;
smoking cessation. J Adolesc Health 2007;41(5):437-43 Health informatics application does not apply to the
consumer; Prochaska J O, Velicer W F, Redding C et al. Stage-based
Other* expert systems to guide a population of primary care
patients to quit smoking, eat healthier, prevent skin cancer,
Penn DL, Simpson LE, Leggett S et al. The development of and receive regular mammograms. Prev Med
a Web site to promote the mental and physical health of 2005;41(2):406-16
sons and daughters of Vietnam veterans of Australia.. No health informatics application
Journal of Consumer Health on the Internet 2006;10(4):45-
63 Proudfoot J, Swain S, Widmer S et al. The development
Health informatics application is for general and beta-test of a computer-therapy program for anxiety
information only AND is not tailored to the individual and depression: Hurdles and lessons. 2003;19(3):277-289
consumer Not a RCT, and not a study addressing barriers;
Other*
Pennbridge J, Moya R, Rodrigues L. Questionnaire survey
of California consumers' use and rating of sources of health Quinn P, Goka J, Richardson H. Assessment of an
care information including the Internet. West J Med electronic daily diary in patients with overactive bladder.
99;171(5-6):302-5 BJU Int 2003;91(7):647-52
Health informatics application is for general No health informatics application
consumer; Ralston J D, Hirsch I B, Hoath J et al. Web-based
Other* collaborative care for type 2 diabetes: a pilot randomized
trial. Diabetes Care 2009;32(2):234-9
Pingree S, Hawkins R P, Gustafson D H et al. Will HIV- Study of a point of care device
positive people use an interactive computer system for
information and support? A study of CHESS in two Ran D, Peretz B. Assessing the pain reaction of children
communities. Proc Annu Symp Comput Appl Med Care receiving periodontal ligament anesthesia using a
93;22-6
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computerized device (Wand). J Clin Pediatr Dent International Diagnostic Interview. Psychiatr Serv
2003;27(3):247-50 97;48(6):815-20
No health informatics application; Study of a point of care device
Ross S E, Nowels C T, Haverhals L M et al. Qualitative
Raphael C, Cornwell J L. Influencing support for assessment of Diabetes-STAR: a patient portal with disease
caregivers. Am J Nurs 2008;108(9 Suppl):78-82; quiz 82 management functions. AMIA Annu Symp Proc 2007;1097
No health informatics application; No original data;
Recabarren M, Nussbaum M, Leiva C. Cultural illiteracy Rosser W W, Hutchison B G, McDowell I et al. Use of
and the Internet. Cyberpsychol Behav 2007;10(6):853-6 reminders to increase compliance with tetanus booster
No health informatics application vaccination. CMAJ 92;146(6):911-7
Renahy E, Parizot I, Chauvin P. Health information seeking Study of a point of care device
on the Internet: a double divide? Results from a
representative survey in the Paris metropolitan area, Rothert K, Strecher V J, Doyle L A et al. Web-based
France, 2005-2006. BMC Public Health 2008;869 weight management programs in an integrated health care
Health informatics application is for general setting: a randomized, controlled trial. Obesity (Silver
information only AND is not tailored to the individual Spring) 2006;14(2):266-72
consumer Study of a point of care device
Resnik D B. Patient access to medical information in the Rotondi A J, Sinkule J, Spring M. An interactive Web-
computer age: ethical concerns and issues. Camb Q Healthc based intervention for persons with TBI and their families:
Ethics 2001;10(2):147-54; discussion 154-6 use and evaluation by female significant others. J Head
No health informatics application; Trauma Rehabil 2005;20(2):173-85
Rigby M, Draper R, Hamilton I. Finding ethical principles consumer
and practical guidelines for the controlled flow of patient
data. Methods Inf Med 99;38(4-5):345-9 Rovniak L S, Hovell M F, Wojcik J R et al. Enhancing
No health informatics application; theoretical fidelity: An e-mail-based walking program
No original data demonstration. American Journal of Health Promotion
2005;20(2):85-95
Rizo C A, Lupea D, Baybourdy H et al. What Internet No health informatics application
services would patients like from hospitals during an
epidemic? Lessons from the SARS outbreak in Toronto. J Rozmovits L, Ziebland S. What do patients with prostate or
Med Internet Res 2005;7(4):e46 breast cancer want from an Internet site? A qualitative
Health informatics application is for general study of information needs. Patient Educ Couns
information only AND is not tailored to the individual 2004;53(1):57-64
consumer; Health informatics application is for general
Study of a point of care device information only AND is not tailored to the individual
consumer
Rogers J L, Haring O M, Goetz J P. Changes in patient
attitudes following the implementation of a medical Rybarczyk B, Lopez M, Schelble K et al. Home-based
information system. QRB Qual Rev Bull 84;10(3):65-74 video CBT for comorbid geriatric insomnia: a pilot study
Health informatics application does not apply to the using secondary data analyses. Behav Sleep Med
consumer; 2005;3(3):158-75
Study of a point of care device No health informatics application
Rosenman S J, Levings C T, Korten A E. Clinical utility Saitz R, Helmuth E D, Aromaa S E et al. Web-based
and patient acceptance of the computerized Composite screening and brief intervention for the spectrum of alcohol
problems. Preventive Medicine 2004;39(5):969-975
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Not a RCT, and not a study addressing barriers services among young-old persons in Switzerland. Int J
Public Health 2007;52(5):313-6
Schinke S, Di Noia J, Schwinn T et al. Drug abuse risk and No health informatics application;
protective factors among black urban adolescent girls: a Health informatics application is for general
group-randomized trial of computer-delivered mother- information only AND is not tailored to the individual
daughter intervention. Psychol Addict Behav consumer
2006;20(4):496-500
Health informatics application does not apply to the Shachak A, Shuval K, Fine S. Barriers and enablers to the
consumer; acceptance of bioinformatics tools: a qualitative study. J
Health informatics application is for general Med Libr Assoc 2007;95(4):454-8
information only AND is not tailored to the individual Health informatics application does not apply to the
consumer consumer
Schinke S, Schwinn T. Gender-specific computer-based Shah A, Kuo A, Zurakowski D et al. Use and satisfaction of
intervention for preventing drug abuse among girls. Am J the internet in obtaining information on brachial plexus
Drug Alcohol Abuse 2005;31(4):609-16 birth palsies and its influence on decision-making. J Pediatr
No health informatics application; Orthop 2006;26(6):781-4
Health informatics application is for general No health informatics application;
information only AND is not tailored to the individual Health informatics application is for general
consumer information only AND is not tailored to the individual
consumer
Schmidt R, Norgall T, Morsdorf J et al. Body Area
Network BAN--a key infrastructure element for patient- Shaw M J, Beebe T J, Tomshine P A et al. A randomized,
centered medical applications. Biomed Tech (Berl) 2002;47 controlled trial of interactive, multimedia software for
Suppl 1 Pt 1365-8 patient colonoscopy education. Journal of Clinical
No original data; Gastroenterology 2001;32(2):142-147
Schumann A, John U, Ulbricht S et al. Computer-generated consumer
tailored feedback letters for smoking cessation: theoretical
and empirical variability of tailoring. Int J Med Inform Shepperd S, Charnock D, Gann B. Helping patients access
2008;77(11):715-22 high quality health information. BMJ 99;319(7212):764-6
No original data; No original data
Other*
Shigaki C L, Smarr K L, Yang Gong et al. Social
Scott C, Byng S. Computer assisted remediation of a interactions in an online self-management program for
homophone comprehension disorder in surface dyslexia. rheumatoid arthritis. Chronic Illn 2008;4(4):239-46
Aphasiology 89;3(3):301-320 Other*
consumer; Silvia K A, Ozanne E M, Sepucha K R. Implementing
Not a RCT and not a study addressing barriers; breast cancer decision aids in community sites: barriers and
Other* resources. Health Expect 2008;11(1):46-53
Secnik K, Pathak D S, Cohen J M. Postcard and telephone consumer
reminders for unclaimed prescriptions: a comparative
evaluation using survival analysis. J Am Pharm Assoc Simoes A A, Bastos F I, Moreira R I et al. Acceptability of
(Wash) 2000;40(2):243-51; quiz 330-1 audio computer-assisted self-interview (ACASI) among
No health informatics application; substance abusers seeking treatment in Rio de Janeiro,
Health informatics application does not apply to the Brazil. Drug Alcohol Depend 2006;82 Suppl 1S103-7
consumer Health informatics application does not apply to the
consumer
Seematter-Bagnoud L, Santos-Eggimann B. Sources and
level of information about health issues and preventive
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Siva C, Smarr K L, Hanson K D et al. Internet use and e- No original data
mail communications between patients and providers: a
survey of rheumatology outpatients. J Clin Rheumatol Steele R, Mummery W K, Dwyer T. Using the Internet to
2008;14(6):318-23 promote physical activity: a randomized trial of
Health informatics application does not apply to the intervention delivery modes. J Phys Act Health
consumer; 2007;4(3):245-60
Skinner C S, Strecher V J, Hospers H. Physicians'
recommendations for mammography: Do tailored messages Stevens V J, Glasgow R E, Toobert D J et al. One-year
make a difference? American Journal of Public Health results from a brief, computer-assisted intervention to
94;84(1):43-49 decrease consumption of fat and increase consumption of
No health informatics application fruits and vegetables. Prev Med 2003;36(5):594-600
Skinner H, Morrison M, Bercovitz K et al. Using the
Internet to engage youth in health promotion. Stock S E, Davies D K, Davies K R et al. Evaluation of an
Promotion & education 1997;4(4):23-25 application for making palmtop computers accessible to
Health informatics application does not apply to the individuals with intellectual disabilities. J Intellect Dev
consumer; Disabil 2006;31(1):39-46
Health informatics application is for general No health informatics application
consumer Stoddard J L, Augustson E M, Moser R P. Effect of adding
a virtual community (bulletin board) to smokefree.gov:
Smaglik P, Hawkins R P, Pingree S et al. The quality of randomized controlled trial. J Med Internet Res
interactive computer use among HIV-infected individuals. 2008;10(5):e53
Journal of Health Communication 1998;3(1):53-68 Health informatics application is for general
Not a RCT, and not a study addressing barriers; information only AND is not tailored to the individual
Other* consumer
Smith D T, Carr L J, Dorozynski C et al. Internet-delivered Stoddard J L, Delucchi K L, Munoz R F et al. Smoking
lifestyle physical activity intervention: limited cessation research via the internet: A feasibility study.
inflammation and antioxidant capacity efficacy in Journal of Health Communication 2005;10(1):27-41
overweight adults. J Appl Physiol 2009;106(1):49-56 Not a RCT and not a study addressing barriers;
Other* Other*
Spallek H, Butler B S, Schleyer T K et al. Supporting Strecher V J, Kreuter M, Den Boer et al. The effects of
emerging disciplines with e-communities: needs and computer-tailored smoking cessation messages in family
benefits. J Med Internet Res 2008;10(2):e19 practice settings. Journal of Family Practice
Health informatics application does not apply to the 1994;39(3):262-270
Other*
Staccini P, Joubert M, Fieschi D et al. Confidentiality
issues within a clinical information system: moving from Strom L, Pettersson R, Andersson G. Internet-based
data-driven to event-driven design. Methods Inf Med treatment for insomnia: a controlled evaluation. J Consult
99;38(4-5):298-302 Clin Psychol 2004;72(1):113-20
No health informatics application; No health informatics application;
Health informatics application does not apply to the Study of a point of care device
consumer
Suggs L S, McIntyre C. Are We There Yet? An
Staccini P, Joubert M, Fieschi D et al. Confidentiality Examination of Online Tailored Health Communication.
issues within a clinical information system: moving from Health Educ Behav 2007;
data-driven to event-driven design. Methods Inf Med No health informatics application;
99;38(4-5):298-302
F-18


Health informatics application is for general Thobaben M. Technology and informatics. Accessibility,
information only AND is not tailored to the individual quality, and readability of health information on the
consumer internet: implication for home health care professionals..
Home Health Care Management & Practice
Svetkey L P, Stevens V J, Brantley P J et al. Comparison of 2002;14(4):295-296
strategies for sustaining weight loss: the weight loss Health informatics application does not apply to the
maintenance randomized controlled trial. JAMA consumer;
2008;299(10):1139-48 No original data
Thompson D, Baranowski T, Cullen K et al. Food, fun, and
Takahashi Y, Satomura K, Miyagishima K et al. A new fitness internet program for girls: pilot evaluation of an e-
smoking cessation programme using the Internet. Tobacco Health youth obesity prevention program examining
Control 1999;8(1):109-110 predictors of obesity. Prev Med 2008;47(5):494-7
Study of a point of care device; Health informatics application is for general
No original data information only AND is not tailored to the individual
consumer
Tan R L. Medicare beneficiaries'' use of computers and
Internet: 1998-2005. Health Care Financing Review Tiller K, Meiser B, Gaff C et al. A randomized controlled
2007;28(2):45-51 trial of a decision aid for women at increased risk of
Health informatics application is for general ovarian cancer. Med Decis Making 2006;26(4):360-72
information only AND is not tailored to the individual No health informatics application
consumer
Titov N, Andrews G, Choi I et al. Shyness 3: randomized
Tate D F, Wing R R, Winett R A. Using Internet controlled trial of guided versus unguided Internet-based
technology to deliver a behavioral weight loss program. CBT for social phobia. Aust N Z J Psychiatry
JAMA 2001;285(9):1172-7 2008;42(12):1030-40
Study of a point of care device Other*
Taub S J. The Internet's role in patient/physician Tjora A, Tran T, Faxvaag A. Privacy vs usability: a
interaction: bringing our understanding in line with online qualitative exploration of patients' experiences with secure
reality. Compr Ophthalmol Update 2006;7(1):25-30 Internet communication with their general practitioner. J
No original data Med Internet Res 2005;7(2):e15
Taylor D P, Bray B E, Staggers N et al. User-centered Health informatics application is for general
development of a Web-based preschool vision screening information only AND is not tailored to the individual
tool. AMIA Annu Symp Proc 2003;654-8 consumer;
Other* Study of a point of care device
Ten Wolde G B, Dijkstra A, van Empelen P et al. Long- Torsney K. Advantages and disadvantages of
term effectiveness of computer-generated tailored patient telerehabilitation for persons with neurological disabilities.
education on benzodiazepines: a randomized controlled NeuroRehabilitation 2003;18(2):183-185
trial. Addiction 2008;103(4):662-70 No original data
Tsang M W, Mok M, Kam G et al. Improvement in
Tetzlaff L. Consumer informatics in chronic illness. J Am diabetes control with a monitoring system based on a hand-
Med Inform Assoc 97;4(4):285-300 held, touch-screen electronic diary. J Telemed Telecare
No health informatics application; 2001;7(1):47-50
Health informatics application is for general Not a RCT, and not a study addressing barriers;
information only AND is not tailored to the individual Other*
consumer;
Other* Tugwell P S, Santesso N A, O'Connor A M et al.
Knowledge translation for effective consumers. Phys Ther
2007;87(12):1728-38
F-19


No health informatics application; Other*
Other*
Wade SL, Wolfe CR, Brown TM et al. Can a Web-based
Tuil W S, Verhaak C M, Braat D D et al. Empowering family problem-solving intervention work for children with
patients undergoing in vitro fertilization by providing traumatic brain injury?. Rehabilitation Psychology
Internet access to medical data. Fertil Steril 2005;50(4):337-345
2007;88(2):361-8 No health informatics application;
No health informatics application; Health informatics application does not apply to the
Health informatics application does not apply to the consumer
consumer
Wagner T H, Greenlick M R. When parents are given
Underhill C, Mckeown L. Getting a second opinion: health greater access to health information, does it affect pediatric
information and the Internet. Health Rep 2008;19(1):65-9 utilization?. Med Care 2001;39(8):848-55
Health informatics application is for general No health informatics application;
information only AND is not tailored to the individual Not a RCT, and not a study addressing barriers
consumer
Walker S N, Pullen C H, Boeckner L et al. Clinical trial of
van den, Berg M H, Ronday H K et al. Using internet tailored activity and eating newsletters with older rural
technology to deliver a home-based physical activity women. Nurs Res 2009;58(2):74-85
intervention for patients with rheumatoid arthritis: A No health informatics application
randomized controlled trial. Arthritis Rheum
2006;55(6):935-45 Wantland D. Content and Functional Assessment of A
Study of a point of care device HIV/AIDS Tailored Web-Based Symptom Self Assessment
and Self Management Tool. Stud Health Technol Inform
van der, Meer V, van Stel H F et al. Internet-based self- 2009;146820-1
management offers an opportunity to achieve better asthma Health informatics application does not apply to the
control in adolescents. Chest 2007;132(1):112-9 consumer
Wantland D. Content and Functional Assessment of A
Van Voorhees B W, Fogel J, Reinecke M A et al. HIV/AIDS Tailored Web-Based Symptom Self Assessment
Randomized clinical trial of an Internet-based depression and Self Management Tool. Stud Health Technol Inform
prevention program for adolescents (Project CATCH-IT) in 2009;146820-1
primary care: 12-week outcomes. J Dev Behav Pediatr Other*
2009;30(1):23-37
Other* Warmerdam L, van Straten A, Cuijpers P. Internet-based
treatment for adults with depressive symptoms: the
van Wier M F, Ariens G A, Dekkers J C et al. Phone and e- protocol of a randomized controlled trial. BMC Psychiatry
mail counselling are effective for weight management in an 2007;772
overweight working population: a randomized controlled Study of a point of care device
trial. BMC Public Health 2009;96
Other* Weinert C, Cudney S, Hill W. Retention in a computer-
based outreach intervention for chronically ill rural women.
van Zutphen M, Milder I E, Bemelmans W J. Integrating an Appl Nurs Res 2008;21(1):23-9
eHealth program for pregnant women in midwifery care: a Health informatics application is for general
feasibility study among midwives and program users. J information only AND is not tailored to the individual
Med Internet Res 2009;11(1):e7 consumer;
Not a RCT, and not a study addressing barriers Study of a point of care device
Vandelanotte C, De Bourdeaudhuij I, Brug J. Acceptability Weingart S N, Rind D, Tofias Z et al. Who uses the patient
and feasibility of an interactive computer-tailored fat intake internet portal? The PatientSite experience. J Am Med
intervention in Belgium. Health Promotion Internation Inform Assoc 2006;13(1):91-5
2004;19(4):463-470 Health informatics application does not apply to the
Not a RCT, and not a study addressing barriers; consumer;
F-20


information only AND is not tailored to the individual Wilson C, Flight I, Hart E et al. Internet access for delivery
consumer of health information to South Australians older than 50.
Aust N Z J Public Health 2008;32(2):174-6
What children think about computers. Future Child Health informatics application is for general
2000;10(2):186-91 information only AND is not tailored to the individual
No health informatics application; consumer;
Health informatics application is for general Other*
consumer Wilson E V, Lankton N K. Modeling patients' acceptance
of provider-delivered e-health. J Am Med Inform Assoc
White M A, Martin P D, Newton R L et al. Mediators of 2004;11(4):241-8
weight loss in a family-based intervention presented over Health informatics application is for general
the internet. Obes Res 2004;12(7):1050-9 information only AND is not tailored to the individual
consumer Wilson P. Searching for the needle in the haystack -- or --
quality criteria for health-related websites.. Health IT
White M. Enhancing process efficiency through remote Advisory Report 2001;3(1):20-23
access. Wireless implementation and remote access enable Health informatics application is for general
medical oncology practice to improve patient and clinician information only AND is not tailored to the individual
confidence while achieving ROI. Health Manag Technol consumer
2004;25(3):42-3
No original data Wilson-Steele G. Improving healthcare through patient
education, patient relationship management. Internet
Whitten P, Mickus M. Home telecare for COPD/CHF Healthc Strateg 2003;5(3):8
patients: outcomes and perceptions. J Telemed Telecare Study of a point of care device;
2007;13(2):69-73 No original data
Winett R A, Anderson E S, Wojcik J R et al. Guide to
Williams A. Surfing over sixty. Making Internet access health: nutrition and physical activity outcomes of a group-
available helps residents stay connected. Provider randomized trial of an Internet-based intervention in
99;25(8):69, 71-2 churches. Ann Behav Med 2007;33(3):251-61
No original data Health informatics application does not apply to the
consumer
Williams G C, Lynch M, Glasgow R E. Computer-assisted
intervention improves patient-centered diabetes care by Wong B M, Yung B M, Wong A et al. Increasing Internet
increasing autonomy support. Health Psychol use among cardiovascular patients: new opportunities for
2007;26(6):728-34 heart health promotion. Can J Cardiol 2005;21(4):349-54
Williams M L, Freeman R C, Bowen A M et al. The consumer
acceptability of a computer HIV/AIDS risk assessment to
not-in-treatment drug users. AIDS Care 98;10(6):701-11 Woolf S H, Krist A H, Johnson R E et al. A practice-
Study of a point of care device sponsored Web site to help patients pursue healthy
behaviors: an ACORN study. Ann Fam Med
Williams R B, Boles M, Johnson R E. A patient-initiated 2006;4(2):148-52
system for preventive health care. A randomized trial in Other*
community-based primary care practices. Arch Fam Med
98;7(4):338-45 Wright J H, Wright A S, Albano A M et al. Computer-
Health informatics application does not apply to the assisted cognitive therapy for depression: maintaining
consumer; efficacy while reducing therapist time. Am J Psychiatry
Study of a point of care device 2005;162(6):1158-64
F-21


No health informatics application; of health information.. Online Brazilian Journal of Nursing
Study of a point of care device 2004;3(2):9p
Zanchetta MS. Understanding functional health literacy in information only AND is not tailored to the individual
experiences with prostate cancer: older men as consumers consumer
List of “other” reasons:
1. Based on data from 2 other trials

2. Book
3. Case study
4. Chess discussion board
5. Cohort study, no control group, no comparison to other methods of testing hearing
6. Commentary--not a study no info
7. Comparing paper based consent form with cd-rom, no tailored info
8. Contact with therapist
9. Contains learning modules only--no tailoring
10. Data not abstractable
11. Description and pilot test
12. Description of the system
13. Development study
14. Development survey
15. Discussion board
16. Doctoral dissertation
17. Electronic diaries only to measure. The study does not examine its impact.
18. Evaluate an internet-based hearing test, no control grp
19. Evaluate the use of a computerized concept for lifestyle
20. Evaluation
21. Focus group--does not address any real barriers
22. Group therapy, no tailored, therapist presence
23. It seems to talk more on lines with group discussion and moderation of group.
24. Descriptive
25. No data comparing experimental and control group; no barriers nor facilitators
26. No data--usage study
27. No health outcomes, just a satisfaction assessment with the system
28. No outcome data available
29. No quantitative data are reported
30. No result
31. No tailored information provided to patients from this application, only to physicians
32. No tailoring required
33. No usable data
34. No usable outcomes, and i really don't think this is a tailored in tailored out study
35. Not about the application but about the parent
36. Not computerized tailored
37. Not tailored and can not isolate the impact of the application from impact of the community chat
38. Not tailored and intervention includes human counseling
39. Not tailored or interactive
40. Not tailored, and there was clinician interaction
41. Only abstract
42. Output is not applied to the patient
43. Overview of a type of full-body sensor
44. Participants had no access to application
45. Patient-centered care
46. Pilot testing of the instrument. Does not look like a study
47. Presence of health care provider -web-based tool to help people to manage their health and improve their
communication with their health care provide
F-22


48. Qualitative analysis of website usage; does not provide barriers nor facilitators
49. Survey on access to the internet
50. Survey on general use
51. Tailoring not required
52. Tailoring occurs at the level of chat group and therapist
53. Tailoring was accomplished in this study by providing flexibility in the number and timing of receipt of message each
day.
54. Telecommunication
55. Telemedicine
56. This is a pilot beta-test
57. This is a study of "use" not any real outcomes
58. Usage study
59. Video informed consent
60. Web based management of diabetes, physician presence
61. Web-based intervention with e-mail counseling
62. Website rating
63. Workplace
F-23

Appendix G
Evidence Table 1. Jadad criteria for RCT quality
Author, year Target RCT Approp of Blinding Approp of WD SCORE

rand. blinding
Key Question 1 a (healthcare process outcomes)
Bartholomew et Asthma 1 0 -1 -1 -1
al.1
Guendelman et 1 0 0 1 2
2
al.,
Jan, 1 0 -1 1 1
3
2007
Krishna, 1 1 1 3
20034
Chewining, Oral contraception 1 -1 0 0
19995 use
Key Question 1 b (intermediate outcomes)
Gustafson, Breast cancer 1 1 0 2
6
2008
Gustafson, 20017 1 0 1
Jones, 1 -1 1 1
8
1999
Adachi, 20079 Diet, exercise, 1 -1 0 0
Anderson, 200110 physical activity 1 -1 0 1 1
(not obesity)
Bruge, 199611 1 1 2
12
Brug, 1998 1 0 0 -1 0
Brug, 199913 1 0 0 1 2
Campbell, 199414 1 0 0 -1 0
15
Campbell, 1999 1 0 0 1 2
Campbell, 200416 1 1 0 -1 1
Haerens, 200517 1 1 0 -1 1
Haerens, 200718 1 1 -1 -1 0
19
Haerens, 2009 1 1 0 -1 1
Hurling, 200620 1 1 0 -1 1
Hurling, 200721 1 1 0 2
22
Jones, 2008 1 0 0 -1 1 1
King, 200623 1 1 0 -1 1
Kristal, 200024 1 1 0 1 3
Low, 200625 1 1 0 2
Lewis, 200826 1 1 0 1 3
Marcus, 200727 1 1 1 3
Mangunkusumo, 1 0 1
28
2007
Napolitano, 1 -1 0 0
200329
Oenema, 200130 1 1 -1 -1 0
Richardson, 1 0 0 1 2
200731
Silk, 1 -1 0
32
2008
Smeets, 200733 1 -1 -1 -1
Spittaels, 200734 1 -1 1 1
Spittaels, 200735 1 0 0 1 2
Tate, 200636 1 1 1 1 0 4
Vandelanotte, 1 0 1
200537
G-1
Evidence Table1. Jadad criteria for RCT quality (continued)

rand. blinding
Verheijden, 1 0 -1 0 0
200438
Winzelberg, 1 -1 0
39
2000
Wylie-Rosett, 1 0 0 -1 0
40
2001
Cunningham , Alcohol 1 -1 1 1
200541
Hester , 200542 1 1 -1 1 2
Kypri , 199943 1 1 1 1 0 4
Lieberman, 1 -1 -1 -1
200644
Neighbors , 1 0 1
200445
Riper, 200846 1 1 -1 1 2
Riper, 200847 1 0 0 1 2
An, 200848 Smoking cessation 1 1 -1 1 2
Brendryen, 2008 1 0 0 1 2
49
Curry, 1995 50 1 0 0 -1 0
Dijkstra, 2005 51 1 0 0 -1 0
Hang, 2009 52 1 1 0 1 3
Japuntich, 200653 1 1 2
Pattents, 200654 1 0 1
Prochaska, 1993 1 0 0 1 2
55
Prokhorov, 2008 1 0 0 1 2
56
Schiffmans, 1 1 1 3
200057
Schumann, 1 -1 -1 -1
58
2006
Schumann, 1 1 -1 1 2
59
2008
Severson, 200860 1 1 2
Strecher, 1994 61 1 0 0 1 2
Study 1
Strecher, 200562 1 -1 -1 -1
Strecher, 2005 63 1 0 0 1
Strecher, 200664 1 -1 0 0
Strecher, 200865 1 -1 -1 0 -1
Swartz, 200666 1 1 -1 0 1
Booth, 200867 Obesity 1 0 1
Burnett, -1 -1 -1 -3
198568
Cussler, 200869 1 1 2
Frenn, 200570 1 -1 -1 0 -2
Hunter, 200871 1 1 -1 1 2
Kent, 198568 -1 -1 -1 -3
Kroeze, 2008 72 1 1 1 3
McConnon, 1 1 -1 0 1
73
2007
G-2

rand. blinding
Morgan , 200974 1 1 0 1 3
Taylor, 1 -1 0
199175
Williamson, 1 1 -1 1 2
200676
Womble, 200477 1 0 1 2
Glasgow, 200378 Diabetes 1 -1 0 0
Homko, 200779 1 -1 1 1
McKay, 200180 1 1 1 3
Richardson, 1 1 -1 1 2
200731
Wangberg, 200681 1 1 2
Wise, 198682 1 1 0 -1 1
Lorig, 200683 Diabetes, heart 1 -1 1 1
disease
Chiauzzi, Mental health 1 1 -1 -1 0
200884
Christensen, 1 1 -1 1 2
85
2004
Hasson, 1 1 -1 1 2
86
2005
Neil, 200987 1 0 0 1 2
Proudfoot, 200488 1 1 1 3
Schneider, 1 -1 1 1
89
2005
Warmerdam, 1 1 0 1 3
200890
Zetterqvist , 1 0 0 1 2
200391
Jan, 20073 Asthma 1 0 -1 1 1
Joseph, 200792 1 1 -1 1 2
Krishna, 20034 1 1 1 3
Nguyen, 200893 COPD 1 1 -1 1 2
Paperny, 199094 Adolescent risk 1 1 0 1 3
behavior
Lorig, Arthritis 1 -1 1 1
200895
Buhrman, Back pain 1 1 2

200496
Oenema, Behavioral risk 1 1 0 1 3

97
2008 factors
Chewning, 19995 Contraception use 1 -1 0 0
Kukafka, Cardio-vascular 1 -1 -1 -1
200298 disease
Jones. 19998 Cancer, general 1 1 1 3
Campbell, 1 -1 -1 -1
199799
Brennan, Caregiver decision 1 1 2
100
1995 making
Yardley, Prevention of falls 1 1 1 1 1 5
101
2007 in the elderly
Harari, Change in health 1 1 -1 0 1
G-3

rand. blinding
2008102 behavior
103
Devineni, 2005 Headache 1 1 2
Flatley-Brennan, HIV/AIDS 1 -1 0 0
104
1998
Schapira, Menopause/HRT 1 1 -1 1 2
2007105
Rostom, 1 1 -1 -1 0
106
2002
Key Question 1 c (relationship-centered outcomes)
Green, 2005107 Breast cancer 1 -1 -1 -1
Gustafson, 20017 1 0 1
108
Maslin, 1998 1 -1 -1 -1
Gustafson, 20086 1 1 0 2
Brennan, 1995100 Caregiver decision 1 1 2
making
Flatley-Brennan, HIV/AIDS 1 -1 0 0
1998104
Sciamanna, Osteoarthritis 1 -1 -1 -1
109
2005
Montgomery, Newborn delivery 1 1 1 3
110
2007
Key Question 1 d (clinical outcomes)
Gustafson, Breast cancer 1 0 1
20017
Gustafson, 1 1 0 2
20086
Maslin, 1 -1 -1 -1
108
1998
Homko, Diabetes 1 -1 1 1
79
2007
Tjam, 2006111 1 1 -1 0 1
Wise, 1986 82 1 1 0 -1 1
Adachi, Diet, exercise, 1 -1 0 0
9
2007 physical activity
Hunter, (not obesity) 1 1 -1 1 2
200871
McConnon, 1 1 -1 0 1
73
2007
Tate, 1 1 1 1 0 4
36
2006
Williamson, 1 1 -1 1 2
200676
Christensen, Mental health 1 1 -1 1 2
200485
Hasson, 200586 1 1 -1 1 2
Kerr, 1 0 1
112
2008
March, 1 1 -1 1 2
113
2008
Orbach, 1 1 -1 0 1
2007114
Proudfoot, 1 1 1 3
2003115
Spek, 1 1 2
116
2008
G-4

rand. blinding
Tarraga, 2006117 Alzheimers 1 -1 0 0
Lorig, Arthritis 1 -1 1 1
200895
Jan, Asthma 1 0 -1 1 1
20073
Buhrman, Back pain 1 1 2
96
2004
Katz, Chronic adult 1 -1 1 1
118
1997 aphasia
Nguyen, COPD 1 1 -1 1 2
200893
Trautman, 2008119 Headache 1 1 1 3
Gustafson, HIV/AIDS 1 1 -1 1 2
1999120
Morgan, 200974 Obesity 1 1 0 1 3
Borckardt, 2007121 Pain 1 -1 0
Key Question 1 e (economic outcomes)
Jones, 19998 Cancer 1 -1 1 1
Joseph, 200792 Asthma 1 1 -1 1 2
McConnon, Obesity 1 1 -1 0 1
73
2007
Key Question 2 (Barriers)
Wangberg, Diabetes 1 1 2
200881
Mangunkusumo, Diet, exercise 1 0 1
200728
G-5
Reference List
1 Bartholomew LK, Gold RS, Parcel GS et al. Watch, Discover, Think, and Act: Evaluation of computer-
assisted instruction to improve asthma self-management in inner-city children. 2000; 39(2-3):269-
80.
2 Guendelman S, Meade K, Benson M, Chen YQ, Samuels S. Improving asthma outcomes and self-
management behaviors of inner-city children: A randomized trial of the Health Buddy interactive
device and an asthma diary. 2002; 156(2):114-20.
3 Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, Liu LF. An internet-based interactive telemonitoring
system for improving childhood asthma outcomes in Taiwan. Telemed J E Health 2007; 13(3):257-
68.
4 Krishna S, Francisco BD, Balas EA, Konig P, Graff GR, Madsen RW. Internet-enabled interactive
multimedia asthma education program: a randomized trial. Pediatrics 2003; 111(3):503-10.
5 Chewning B, Mosena P, Wilson D et al. Evaluation of a computerized contraceptive decision aid for
adolescent patients. Patient Educ Couns 1999; 38(3):227-39.
6 Gustafson DH, Hawkins R, Mctavish F et al. Internet-based interactive support for cancer patients: Are
integrated systems better? 2008; 58(2):238-57.
7 Gustafson DH, Hawkins R, Pingree S et al. Effect of computer support on younger women with breast
cancer. J Gen Intern Med 2001; 16(7):435-45.
8 Jones R, Pearson J, McGregor S et al. Randomised trial of personalised computer based information for
cancer patients. BMJ 1999; 319(7219):1241-7.
9 Adachi Y, Sato C, Yamatsu K, Ito S, Adachi K, Yamagami T. A randomized controlled trial on the long-term
effects of a 1-month behavioral weight control program assisted by computer tailored advice. Behav
Res Ther 2007; 45(3):459-70.
10 Anderson ES, Winett RA, Wojcik JR, Winett SG, Bowden T. A computerized social cognitive intervention
for nutrition behavior: Direct and mediated effects on fat, fiber, fruits, and vegetables, self-efficacy,
and outcome expectations among food shoppers. 2001; 23(2):88-100.
11 Brug J, Steenhuis I, Van Assema P, De Vries H. The impact of a computer-tailored nutrition intervention.
1996; 25(3):236-42.
12 Brug J, Glanz K, Van Assema P, Kok G, Van Breukelen GJP. The Impact of Computer-Tailored Feedback
and Iterative Feedback on Fat, Fruit, and Vegetable Intake. 1998; 25(4):517-31.
13 Brug J, Steenhuis I, Van Assema P, Glanz K, De Vries H. Computer-tailored nutrition education: Differences
between two interventions. 1999; 14(2):249-56.
14 Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary
behavior: The effectiveness of tailored messages in primary care settings. 1994; 84(5):783-7.
15 Campbell MK, Honess-Morreale L, Farrell D, Carbone E, Brasure M. A tailored multimedia nutrition

education pilot program for low-income women receiving food assistance. 1999; 14(2):257-67.
16 Campbell MK, Carbone E, Honess-Morreale L, Heisler-MacKinnon J, Demissie S, Farrell D. Randomized

trial of a tailored nutrition education CD-ROM program for women receiving food assistance. 2004;
G-6
36(2):58-66.
17 Haerens L, De Bourdeaudhuij I, Maes L, Vereecken C, Brug J, Deforche B. The effects of a middle-school

healthy eating intervention on adolescents' fat and fruit intake and soft drinks consumption. 2007;
10(5):443-9.
18 Haerens L, Deforche B, Maes L, Brug J, Vandelanotte C, De Bourdeaudhuij I. A computer-tailored dietary fat

intake intervention for adolescents: results of a randomized controlled trial. Ann Behav Med 2007;
34(3):253-62.
19 Haerens L, Maes L, Vereecken C, De Henauw S, Moreno L, De Bourdeaudhuij I. Effectiveness of a computer

tailored physical activity intervention in adolescents compared to a generic advice. Patient Educ
Couns 2009.
20 Hurling R, Fairley BW, Dias MB. Internet-based exercise intervention systems: Are more interactive designs
better? 2006; 21(6):757-72.
21 Hurling R, Catt M, Boni MD et al. Using internet and mobile phone technology to deliver an automated
physical activity program: randomized controlled trial. J Med Internet Res 2007; 9(2):e7.
22 Jones M, Luce KH, Osborne MI et al. Randomized, controlled trial of an internet-facilitated intervention for
reducing binge eating and overweight in adolescents. Pediatrics 2008; 121(3):453-62.
23 King DK, Estabrooks PA, Strycker LA, Toobert DJ, Bull SS, Glasgow RE. Outcomes of a multifaceted
physical activity regimen as part of a diabetes self-management intervention. 2006; 31(2):128-37.
24 Kristal AR, Curry SJ, Shattuck AL, Feng Z, Li S. A randomized trial of a tailored, self-help dietary
intervention: The puget sound eating patterns study. 2000; 31(4):380-9.
25 Low KG, Charanasomboon S, Lesser J et al. Effectiveness of a computer-based interactive eating disorders
prevention program at long-term follow-up. Eat Disord 2006; 14(1):17-30.
26 Lewis B, Williams D, Dunsiger S et al. User attitudes towards physical activity websites in a randomized
controlled trial. Prev Med 2008; 47(5):508-13.
27 Marcus BH, Lewis BA, Williams DM et al. A comparison of Internet and print-based physical activity
interventions. Arch Intern Med 2007; 167(9):944-9.
28 Mangunkusumo R, Brug J, Duisterhout J, de Koning H, Raat H. Feasibility, acceptability, and quality of

Internet-administered adolescent health promotion in a preventive-care setting. Health Educ Res
2007; 22(1):1-13.
29 Napolitano MA, Fotheringham M, Tate D et al. Evaluation of an internet-based physical activity intervention:
a preliminary investigation. Ann Behav Med 2003; 25(2):92-9.
30 Oenema A, Brug J, Lechner L. Web-based tailored nutrition education: results of a randomized controlled
trial. Health Educ Res 2001; 16(6):647-60.
31 Richardson CR, Mehari KS, McIntyre LG et al. A randomized trial comparing structured and lifestyle goals
in an internet-mediated walking program for people with type 2 diabetes. Int J Behav Nutr Phys Act
2007; 4:59.
32 Silk KJ, Sherry J, Winn B, Keesecker N, Horodynski MA, Sayir A. Increasing nutrition literacy: testing the
effectiveness of print, web site, and game modalities. J Nutr Educ Behav 2008; 40(1):3-10.
G-7
33 Smeets T, Kremers SP, Brug J, de Vries H. Effects of tailored feedback on multiple health behaviors. Ann
Behav Med 2007; 33(2):117-23.
34 Spittaels H, De Bourdeaudhuij I, Brug J, Vandelanotte C. Effectiveness of an online computer-tailored

physical activity intervention in a real-life setting. Health Educ Res 2007; 22(3):385-96.
35 Spittaels H, De Bourdeaudhuij I, Vandelanotte C. Evaluation of a website-delivered computer-tailored

intervention for increasing physical activity in the general population. 2007; 44(3):209-17.
36 Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-
automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern
Med 2006; 166(15):1620-5.
37 Vandelanotte C, De Bourdeaudhuij I, Sallis JF, Spittaels H, Brug J. Efficacy of sequential or simultaneous

interactive computer-tailored interventions for increasing physical activity and decreasing fat intake.
Ann Behav Med 2005; 29(2):138-46.
38 Verheijden M, Bakx JC, Akkermans R et al. Web-based targeted nutrition counselling and social support for
patients at increased cardiovascular risk in general practice: randomized controlled trial. J Med
Internet Res 2004; 6(4):e44.
39 Winzelberg AJ, Eppstein D, Eldredge KL et al. Effectiveness of an Internet-based program for reducing risk
factors for eating disorders. J Consult Clin Psychol 2000; 68(2):346-50.
40 Wylie-Rosett J, Swencionis C, Ginsberg M et al. Computerized weight loss intervention optimizes staff time:
The clinical and cost results of a controlled clinical trial conducted in a managed care setting. 2001;
101(10):1155-62.
41 Cunningham JA, Humphreys K, Koski-Jannes A, Cordingley J. Internet and paper self-help materials for
problem drinking: is there an additive effect? Addict Behav 2005; 30(8):1517-23.
42 Hester RK, Squires DD, Delaney HD. The Drinker's Check-up: 12-month outcomes of a controlled clinical
trial of a stand-alone software program for problem drinkers. J Subst Abuse Treat 2005; 28(2):159-
69.
43 Kypri K, Saunders JB, Williams SM et al. Web-based screening and brief intervention for hazardous
drinking: a double-blind randomized controlled trial. Addiction 2004; 99(11):1410-7.
44 Lieberman DZ. Effects of a personified guide on adherence to an online program for alcohol abusers.
Cyberpsychol Behav 2006; 9(5):603-7.
45 Neighbors C, Larimer ME, Lewis MA. Targeting misperceptions of descriptive drinking norms: efficacy of a
computer-delivered personalized normative feedback intervention. J Consult Clin Psychol 2004;
72(3):434-47.
46 Riper H, Kramer J, Smit F, Conijn B, Schippers G, Cuijpers P. Web-based self-help for problem drinkers: a
pragmatic randomized trial. Addiction 2008; 103(2):218-27.
47 Riper H, Kramer J, Keuken M, Smit F, Schippers G, Cuijpers P. Predicting successful treatment outcome of
web-based self-help for problem drinkers: secondary analysis from a randomized controlled trial. J
Med Internet Res 2008; 10(4):e46.
48 An LC, Klatt C, Perry CL et al. The RealU online cessation intervention for college smokers: a randomized
controlled trial. Prev Med 2008; 47(2):194-9.
G-8
49 Brendryen H, Drozd F, Kraft P. A digital smoking cessation program delivered through internet and cell
phone without nicotine replacement (happy ending): randomized controlled trial. J Med Internet Res
2008; 10(5):e51.
50 Curry SJ, McBride C, Grothaus LC, Louie D, Wagner EH. A randomized trial of self-help materials,
personalized feedback, and telephone counseling with nonvolunteer smokers. 1995; 63(6):1005-14.
51 Dijkstra A. Working mechanisms of computer-tailored health education: Evidence from smoking cessation.
2005; 20(5):527-39.
52 Haug S, Meyer C, Schorr G, Bauer S, John U. Continuous individual support of smoking cessation using text
messaging: A pilot experimental study. Nicotine Tob Res 2009.
53 Japuntich SJ, Zehner ME, Smith SS et al. Smoking cessation via the internet: a randomized clinical trial of an
internet intervention as adjuvant treatment in a smoking cessation intervention. Nicotine Tob Res
2006; 8 Suppl 1:S59-67.
54 Patten CA, Croghan IT, Meis TM et al. Randomized clinical trial of an Internet-based versus brief office
intervention for adolescent smoking cessation. Patient Educ Couns 2006; 64(1-3):249-58.
55 Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. Standardized, Individualized, Interactive, and
Personalized Self-Help Programs for Smoking Cessation. 1993; 12(5):399-405.
56 Prokhorov AV, Kelder SH, Shegog R et al. Impact of A Smoking Prevention Interactive Experience
(ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally
diverse high-school students. Nicotine Tob Res 2008; 10(9):1477-85.
57 Shiffman S, Paty JA, Rohay JM, Di Marino ME, Gitchell J. The efficacy of computer-tailored smoking
cessation material as a supplement to nicotine polacrilex gum therapy. Arch Intern Med 2000;
160(11):1675-81.
58 Schumann A, John U, Rumpf H-J, Hapke U, Meyer C. Changes in the "stages of change" as outcome
measures of a smoking cessation intervention: A randomized controlled trial. 2006; 43(2):101-6.
59 Schumann A, John U, Baumeister SE, Ulbricht S, Rumpf HJ, Meyer C. Computer-tailored smoking cessation
intervention in a general population setting in Germany: outcome of a randomized controlled trial.
Nicotine Tob Res 2008; 10(2):371-9.
60 Severson HH, Gordon JS, Danaher BG, Akers L. ChewFree.com: evaluation of a Web-based cessation
program for smokeless tobacco users. Nicotine Tob Res 2008; 10(2):381-91.
61 Strecher VJ, Kreuter M, Den Boer D-J, Kobrin S, Hospers HJ, Skinner CS. The effects of computer-tailored
smoking cessation messages in family practice settings. 1994; 39(3):262-70.
62 Strecher VJ, Shiffman S, West R. Randomized controlled trial of a web-based computer-tailored smoking
cessation program as a supplement to nicotine patch therapy. Addiction 2005; 100(5):682-8.
63 Strecher VJ, Marcus A, Bishop K et al. A randomized controlled trial of multiple tailored messages for
smoking cessation among callers to the cancer information service. J Health Commun 2005; 10
Suppl 1:105-18.
64 Strecher VJ, Shiffman S, West R. Moderators and mediators of a web-based computer-tailored smoking
cessation program among nicotine patch users. Nicotine Tob Res 2006; 8 Suppl 1:S95-101.
65 Strecher VJ, McClure JB, Alexander GL et al. Web-based smoking-cessation programs: results of a
G-9
randomized trial. Am J Prev Med 2008; 34(5):373-81.
66 Swartz LH, Noell JW, Schroeder SW, Ary DV. A randomised control study of a fully automated internet
based smoking cessation programme. Tob Control 2006; 15(1):7-12.
67 Booth AO, Nowson CA, Matters H. Evaluation of an interactive, Internet-based weight loss program: a pilot
study. Health Educ Res 2008; 23(3):371-81.
68 Burnett KF, Taylor CB, Agras WS. Ambulatory computer-assisted therapy for obesity: A new frontier for
behavior therapy. 1985; 53(5):698-703.
69 Cussler EC, Teixeira PJ, Going SB et al. Maintenance of weight loss in overweight middle-aged women
through the Internet. Obesity (Silver Spring) 2008; 16(5):1052-60.
70 Frenn M, Malin S, Brown RL et al. Changing the tide: An Internet/video exercise and low-fat diet
intervention with middle-school students. 2005; 18(1):13-21.
71 Hunter CM, Peterson AL, Alvarez LM et al. Weight management using the internet a randomized controlled
trial. Am J Prev Med 2008; 34(2):119-26.
72 Kroeze W, Oenema A, Campbell M, Brug J. The efficacy of Web-based and print-delivered computer-
tailored interventions to reduce fat intake: results of a randomized, controlled trial. J Nutr Educ
Behav 2008; 40(4):226-36.
73 McConnon A, Kirk SF, Cockroft JE et al. The Internet for weight control in an obese sample: results of a
randomised controlled trial. BMC Health Serv Res 2007; 7:206.
74 Morgan PJ, Lubans DR, Collins CE, Warren JM, Callister R. The SHED-IT Randomized Controlled Trial:
Evaluation of an Internet-based Weight-loss Program for Men. Obesity (Silver Spring) 2009.
75 Taylor CB, Agras WS, Losch M, Plante TG, Burnett K. Improving the effectiveness of computer-assisted
weight loss. 1991; 22(2):229-36.
76 Williamson DA, Walden HM, White MA et al. Two-year internet-based randomized controlled trial for
weight loss in African-American girls. Obesity (Silver Spring) 2006; 14(7):1231-43.
77 Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized
controlled trial of a commercial internet weight loss program. Obes Res 2004; 12(6):1011-8.
78 Glasgow RE, Boles SM, McKay HG, Feil EG, Barrera M Jr. The D-Net diabetes self-management program:
long-term implementation, outcomes, and generalization results. Prev Med 2003; 36(4):410-9.
79 Homko CJ, Santamore WP, Whiteman V et al. Use of an internet-based telemedicine system to manage
underserved women with gestational diabetes mellitus. Diabetes Technol Ther 2007; 9(3):297-306.
80 McKay HG, King D, Eakin EG, Seeley JR, Glasgow RE. The diabetes network internet-based physical
activity intervention: a randomized pilot study. Diabetes Care 2001; 24(8):1328-34.
81 Wangberg SC. An Internet-based diabetes self-care intervention tailored to self-efficacy. Health Educ Res
2008; 23(1):170-9.
82 Wise PH, Dowlatshahi DC, Farrant S. Effect of computer-based learning on diabetes knowledge and control.
1986; 9(5):504-8.
83 Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized
G-10
trial. Med Care 2006; 44(11):964-71.
84 Chiauzzi E, Brevard J, Thurn C, Decembrele S, Lord S. MyStudentBody-Stress: an online stress management

intervention for college students. J Health Commun 2008; 13(6):555-72.
85 Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet:
randomised controlled trial. BMJ 2004; 328(7434):265.
86 Hasson D, Anderberg UM, Theorell T, Arnetz BB. Psychophysiological effects of a web-based stress
management system: a prospective, randomized controlled intervention study of IT and media
workers. BMC Public Health 2005; 5:78.
87 Neil AL, Batterham P, Christensen H, Bennett K, Griffiths KM. Predictors of adherence by adolescents to a
cognitive behavior therapy website in school and community-based settings. J Med Internet Res
2009; 11(1):e6.
88 Proudfoot J, Ryden C, Everitt B et al. Clinical efficacy of computerised cognitive-behavioural therapy for
anxiety and depression in primary care: randomised controlled trial. Br J Psychiatry 2004; 185:46-
54.
89 Schneider AJ, Mataix-Cols D, Marks IM, Bachofen M. Internet-guided self-help with or without exposure
therapy for phobic and panic disorders. Psychother Psychosom 2005; 74(3):154-64.
90 Warmerdam L, van Straten A, Twisk J, Riper H, Cuijpers P. Internet-based treatment for adults with
depressive symptoms: randomized controlled trial. J Med Internet Res 2008; 10(4):e44.
91 Zetterqvist K, Maanmies J, Str+¦m L, Andersson G. Randomized controlled trial of internet-based stress

management. 2003; 32(3):151-60.
92 Joseph CL, Peterson E, Havstad S et al. A web-based, tailored asthma management program for urban
African-American high school students. Am J Respir Crit Care Med 2007; 175(9):888-95.
93 Nguyen HQ, Donesky-Cuenco D, Wolpin S et al. Randomized controlled trial of an internet-based versus
face-to-face dyspnea self-management program for patients with chronic obstructive pulmonary
disease: pilot study. J Med Internet Res 2008; 10(2):e9.
94 Paperny DM, Aono JY, Lehman RM, Hammar SL, Risser J. Computer-assisted detection and intervention in
adolescent high-risk health behaviors. 1990; 116(3):456-62.
95 Lorig KR, Ritter PL, Laurent DD, Plant K. The internet-based arthritis self-management program: a one-year
randomized trial for patients with arthritis or fibromyalgia. Arthritis Rheum 2008; 59(7):1009-17.
96 Buhrman M, Faltenhag S, Strom L, Andersson G. Controlled trial of Internet-based treatment with telephone
support for chronic back pain. Pain 2004; 111(3):368-77.
97 Oenema A, Brug J, Dijkstra A, de Weerdt I, de Vries H. Efficacy and use of an internet-delivered computer-
tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation:
a randomized controlled trial. Ann Behav Med 2008; 35(2):125-35.
98 Kukafka R, Lussier YA, Eng P, Patel VL, Cimino JJ. Web-based tailoring and its effect on self-efficacy:
results from the MI-HEART randomized controlled trial. Proc AMIA Symp 2002; 410-4.
99 Campbell E, Peterkin D, Abbott R, Rogers J. Encouraging underscreened women to have cervical cancer
screening: the effectiveness of a computer strategy. Prev Med 1997; 26(6):801-7.
G-11
100 Brennan PF, Moore SM, Smyth KA. The effects of a special computer network on caregivers of persons with
Alzheimer's disease. Nurs Res 1995; 44(3):166-72.
101 Yardley L, Nyman SR. Internet provision of tailored advice on falls prevention activities for older people: a
randomized controlled evaluation. Health Promot Int 2007; 22(2):122-8.
102 Harari D, Iliffe S, Kharicha K et al. Promotion of health in older people: a randomised controlled trial of
health risk appraisal in British general practice. Age Ageing 2008; 37(5):565-71.
103 Devineni T, Blanchard EB. A randomized controlled trial of an internet-based treatment for chronic
headache. Behav Res Ther 2005; 43(3):277-92.
104 Flatley-Brennan P. Computer network home care demonstration: a randomized trial in persons living with
AIDS. Comput Biol Med 1998; 28(5):489-508.
105 Schapira MM, Gilligan MA, McAuliffe T, Garmon G, Carnes M, Nattinger AB. Decision-making at
menopause: a randomized controlled trial of a computer-based hormone therapy decision-aid. Patient
Educ Couns 2007; 67(1-2):100-7.
106 Rostom A, O'Connor A, Tugwell P, Wells G. A randomized trial of a computerized versus an audio-booklet
decision aid for women considering post-menopausal hormone replacement therapy. Patient Educ
Couns 2002; 46(1):67-74.
107 Green MJ, Peterson SK, Baker MW et al. Use of an educational computer program before genetic counseling
for breast cancer susceptibility: effects on duration and content of counseling sessions. Genet Med
2005; 7(4):221-9.
108 Maslin AM, Baum M, Walker JS, A'Hern R, Prouse A. Using an interactive video disk in breast cancer
patient support. Nurs Times 1998; 94(44):52-5.
109 Sciamanna CN, Harrold LR, Manocchia M, Walker NJ, Mui S. The effect of web-based, personalized,
osteoarthritis quality improvement feedback on patient satisfaction with osteoarthritis care. Am J
Med Qual 2005; 20(3):127-37.
110 Montgomery AA, Emmett CL, Fahey T et al. Two decision aids for mode of delivery among women with
previous caesarean section: randomised controlled trial. BMJ 2007; 334(7607):1305.
111 Tjam EY, Sherifali D, Steinacher N, Hett S. Physiological outcomes of an internet disease management
program vs. in-person counselling: A randomized, controlled trial. 2006; 30(4):397-405.
112 Kerr J, Patrick K, Norman G et al. Randomized control trial of a behavioral intervention for overweight
women: impact on depressive symptoms. Depress Anxiety 2008; 25(7):555-8.
113 March S, Spence SH, Donovan CL. The Efficacy of an Internet-Based Cognitive-Behavioral Therapy
Intervention for Child Anxiety Disorders. J Pediatr Psychol 2008.
114 Orbach G, Lindsay S, Grey S. A randomised placebo-controlled trial of a self-help Internet-based intervention
for test anxiety. Behav Res Ther 2007; 45(3):483-96.
115 Proudfoot J, Goldberg D, Mann A, Everitt B, Marks I, Gray JA. Computerized, interactive, multimedia
cognitive-behavioural program for anxiety and depression in general practice. Psychol Med 2003;
33(2):217-27.
116 Spek V, Cuijpers P, Nyklicek I et al. One-year follow-up results of a randomized controlled clinical trial on
internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years.
G-12
Psychol Med 2008; 38(5):635-9.
117 Tarraga L, Boada M, Modinos G et al. A randomised pilot study to assess the efficacy of an interactive,
multimedia tool of cognitive stimulation in Alzheimer's disease. J Neurol Neurosurg Psychiatry
2006; 77(10):1116-21.
118 Katz RC, Wertz RT. The efficacy of computer-provided reading treatment for chronic aphasic adults. J
Speech Lang Hear Res 1997; 40(3):493-507.
119 Trautmann E, Kro?ner-Herwig B. Internet-based self-help training for children and adolescents with recurrent
headache: A pilot study. 2008; 36(2):241-5.
120 Gustafson DH, Hawkins R, Boberg E et al. Impact of a patient-centered, computer-based health
information/support system. Am J Prev Med 1999; 16(1):1-9.
121 Borckardt JJ, Younger J, Winkel J, Nash MR, Shaw D. The computer-assisted cognitive/imagery system for
use in the management of pain. Pain Res Manag 2004; 9(3):157-62.
G-13
Evidence Table 10. All outcomes KQ1b, impact of CHI application on intermediate outcomes
Control Measure Measure at Ratios

Author, Measure Measure at Measure at at time final time at time
year Outcomes Intervention n at BL time point 2 time point 3 point 4 point points Significance
diet/exercise/physical activity NOT obesity
Adachi, Body Weight Control 50 Mean, 65.1 1 month 3 month 7 month: BL,
1 SD, 6.4 mean, -3 mean, -1.1 mean, -1.4 time point 2,
2007
SD, 0.9 SD, 1.5 SD, 2.4 0.01
time point 3,
0.01
final time
point, 0.05
Computer 36 Mean, 65.3 1 month 3 month 7 month: BL,
tailored SD, 6.4 mean, -1.1 mean, -2.3 mean, -2.9 time point 2,
program with SD, 1.2 SD, 2 SD, 2.7 0.01
6-month time point 3,
weight and 0.01
targeted final time
behavior’s point, 0.05
self-
monitoring,
Computer 44 Mean, 64.8 1 month 3 month 7 month: BL,
program SD, 1.1 SD, 1.9 SD, 3 0.01
only, time point 3,
0.01
final time
point, 0.05
Untailored 53 Mean, 63.4 1 month 3 month 7 month: BL,
self-help SD, 5.5 mean, -0.5 mean, -1.3 mean, -1.6 time point 2,
booklet with SD, 0.8 SD, 1.5 SD, 2.1 0.01
7-month self- time point 3,
monitoring of 0.01
weight and final time
walking point, 0.05
BMI Control 50 Mean, 26.1 1 month 3 month 7 month BL,
SD, 1.6 mean, -0.14 mean, -0.44 mean, -0.57 time point 2,
SD, 0.38 SD, 0.6 SD, 0.93 0.01
time point 3,
0.01
final time
point, 0.05
G‐65

Evidence Table 10. All outcomes KQ1b, impact of CHI application on intermediate outcomes (continued)

Computer 36 Mean, 26.2 1 month 3 month 7 month BL,
program with SD, 0.49 SD, 0.85 SD, 1.16 0.01
weight and 0.01
targeted final time
self-
monitoring
Computer 44 Mean, 26.2 1 month 3 month 7 month BL,
program only SD, 0.42 SD, 0.73 SD, 1.15 0.01
time point 3,
0.01
final time
point, 0.05
Untailored 53 Mean, 26.1 1 month 3 month 7 month BL,
self-help SD, 1.5 mean, -0.2 mean, -0.53 mean, -0.68 time point 2,
monitoring of 0.01
weight and final time
walking, point, 0.05
% weight loss Control 50 1 month 3 month 7 month BL,
mean, -0.05 mean, -1.6 mean, -2.2 time point 2,
SD, 1.4 SD, 2.3 SD, 3.5 0.01
time point 3,
0.01
final time
point, 0.05
Computer 36 1 month 3 month 7 month BL,
tailored mean, -1.8 mean, -3.6 mean, 4.7 time point 2,
program with SD, 1.9 SD, 3.3 SD, 4.5 0.01
weight and 0.01
targeted final time
self-
G‐66


monitoring,
Computer 44 1 month 3 month 7 month BL,
tailored mean, -1.5 mean, -2.6 mean, -3.3 time point 2,
program only SD, 1.6 SD, 2.8 SD, 4.3 0.01
time point 3,
0.01
final time
point, 0.05
Untailored 53 1 month 3 month 7 month BL,
self-help mean, -0.8 mean, -2 mean, -2.6 time point 2,
monitoring of 0.01
weight and time point 4,
walking final time
point, 0.05
Anderson, Fat (% Control 137 32.74 (6.85) 33.19 (6.93) NS NS
2
2001 calories) n 90
Composites
Scores mean Intervention 124 33.24 (7.28) 31.00 (6.42) NS NS
(SD) n 72
Fiber Control NS 9.00(3.32) 9.21(3.26) n NS NS

(g/1,000kcals) 90
mean (SD)
Intervention NS 8.97 (2.57) 10.61 (3.37) NS NS
n 72
Fruit and Control 136 2.85 (1.34) 2.5 (1.18) n NS NS

vegetables 90
(servings/1000
kcals) mean Intervention 124 2.78 (1.06) 3.35 (1.56) n NS NS
(SD) 72
Self Efficacy/ Control 139 6.70 (1.79) 6.68 (1.73)
G‐67


Low-Fat Meals Intervention 125 6.89 (1.82) 7.01 (1.67) NS P<.10
mean (SD)
Self-Efficacy/ Control 139 7.24 (1.67) 7.18 (1.61) n NS NS

Low-Fat 132
Snacks mean
(SD) Intervention 125 7.29 (1.86) 7.38 (1.80) n NS NS
98
Self- Control 139 7.29 (1.78) 7.38 (1.67) n NS NS

Efficacy/Fruit, 132
Vegetables,
Fiber mean Intervention 125 7.50 (1.58) 7.58 (1.73) n NS NS
(SD) 98
Outcome Control 139 3.92 (0.90) 3.94 (0.91) n NS NS

Expectations/A 132
ppetite
Satisfaction Intervention 125 3.97 (0.93) 4.13 (0.88) n NS P<.10
mean (SD) 98

Expectations/B 132
udgetary
Outcomes Intervention 125 3.40 (1.10) 3.39 (1.14 ) n NS NS
mean (SD) 98

Expectations/H 132
ealth
Outcomes Intervention 125 4.37 (0.59) 4.40 (0.58) n NS NS
mean (SD) 98
G‐68


Brug, Fat (fat points General 220 28.2 (5.2) 27.5 (5.6) NS NS
19983 per day) Information
Tailored + 215 28.3 (5.4) 25.6 (4.6) NS NS

Iterative
feedback
Tailored 211 28.0 (5.3) 26.2 (5.2) NS Group effect

Feedback F(2) 17. 1, p
< .001
Fruit (servings General 220 2.09 (1.75) 2.02 (1.59) NS NS

per day) Information
Tailored + 215 2.13 (1.70) 2.45 (1.69) NS NS

Iterative
feedback

Feedback F(2) 5.5, p <
.01
Vegetables General 220 1.02 (0.36) 1.08 (0.41) NS NS

(servings per Information
day)
Tailored + 215 1.06 (0.38) 1.20 (0.36) NS NS

Iterative
feedback
G‐69


Feedback F(2) 5.2, p <
.01.
Brug, Fat score Comparison 163 27.4 25.9 NS NS

19994
Experimental 152 26.5 26.2 NS NS
Servings of Comparison 163 1.04 1.13 NS P<.01 at

vegetables baseline
Servings of Comparison 163 1.61 1.91 NS NS

fruit
Intention to Comparison 163 .11 .50 NS NS

reduce fat
(Range: 23 Experimental 152 .26 .37 NS NS
(very surely
not) to 13 (very
sure).
Intention to Comparison 163 -.91 -.47 NS NS

increase
vegetables Experimental 152 -1.21 -.51 NS NS
Range: 23
(very surely
not) to 13 (very
sure).
G‐70


Intention to Comparison 163 -0.40 -0.13 NS NS

increase fruit
dRange: 23 Experimental 152 -0.31 -0.17 NS NS
(very surely
not) to 13 (very
sure).
Campbell, Fat no message NS 41,1 (2,1) 39,8(1,9) NS NS

5
1994 (g/day)Mean
(SE) tailored NS 45,6 (2,6) 35,3(1,7) NS 33
message
Non tailored NS 40,4 (2,4) 36,8(1,7) NS 157

message
Saturated Fat no message NS 16,3 (,98) 15.8 (,81) NS NS

(g/day) Mean
(SE) tailored NS 18,7(1,1) 13,9 (.72) NS ,036
message
Non tailored NS 16,1 (.93) 14.4 (.72) NS ,110

message
Vegetable/Fruit no message NS 3,6 (.20) 3.3 (.20) NS NS

(servings/day)
Mean (SE) tailored NS 3,6 (.19) 3,3 (,19) NS 0.817
message
G‐71


Non tailored NS 3,6 (.20) 3,3 (.19) NS ,968
message
Computer- NS 40.7 ± 14.4 31.6 ± 12.4 NS NS

tailored
intervention
Standard NS 35.6 ± 14.2 33.3 ± 12.9 NS NS

intervention
Total fat intake No NS 100.3 ± 39.9 97.1 ± 40.3 NS NS

(grams/ intervention
day) a , b
Computer- NS 109.2 ± 40.7 85.0 ± 34.5 NS NS
tailored
intervention
Standard NS 87.5 ± 35.9 81.8 ± 33.3 NS NS

intervention
Campbell, Knowledge Control 212 4.13 (0.08) N 4.33 (0.08) NS NS

6
1999 score of low fat Sig P<0.001
foods
Intervention 165 4.29 (0.09) N 5.08 (0.09) NS NS
Sig P<0.001
Self-efficacy Control 212 3.53 (0.08) N 3.83 (0.07) NS NS

Sig N Sig
Intervention 165 3.55 (0.09) N 3.94 (0.08) N NS NS

Sig Sig
Fat score (g) Control 212 101.6 (4.2) 65.5 (2.8) N NS NS

P<0.001 Sig
G‐72


Intervention 165 83.8 (4.7) 64.1 (3.2) N NS NS
P<0.001 Sig
Stage of Control 212 31 (14.6) 18 (8.5) –6.6 P <0.01 for

change- baseline
Precontemplati difference in
on n (%) stage of
change
between
study groups
Intervention 165 14 (8.5) 9 (5.4) –3.1 NS
Stage of Control 212 72 (34.0) 47 (22.1) –11.9 NS

change-
Contemplation Intervention 165 71 (43.0) 26 (15.8) –37.2 NS
n (%)
Stage of Control 212 30 (14.2) 39 (18.3) +4.1 NS

change-
Preparation n Intervention 165 35 (21.2) 41 (24.8) +3.6 NS
(%)
Stage of Control 212 79 (37.3) 109 (51.2) +13.9 NS

change-
Action/mainten Intervention 165 45 (27.3) 89 (53.9) +26.6 P 0.03 for
ance n (%) difference
P 0.01 between
compari study groups
ng in number of
stage people who
progres were in more
s, more advanced
people stages
G‐73


in the (preparation,
interven action/
tion
group maintenance
advanc ) at follow-up,
ed in intervention .
stage control.
compar
ed to
the
control
group.
Campbell, Total Low-fat Control-No 166 1.86(1.2) 2.63 (0.55) NS NS

20047 Intervention
knowledge
score
Computer 141 1.94(1.2) 2.76 (0.46) NS P ( .02).
based
interactive
nutrition
education
Total Infant Control-No 166 2.25 (0.86) 2.40 (0.75) NS NS

feeding Intervention
knowledge
score Computer 141 2.29 (0.82) 2.62 (0.62)* NS (P < .01).
based
interactive
nutrition
education
G‐74


Total self- Control-No 166 17.08 18.48 NS NS
efficacy score Intervention
Computer 141 17.68 18.93 NS NS

based (significant
interactive increase at
nutrition Immediate
education
Follow-up
19.51, P <
.05
Haerens, Fat intake (g control (n 108 ± 46 104 ± 45 NS NS

8
2005 day21) condition 655
pupil
s)
intervention (n 111 ± 48 105 ± 49 NS NS

with parental 1055
support pupil
s)
intervention (n 130 ± 54 127 ± 56 NS NS

alone 685
pupil
s)
Fruit intake control (n 6.5 ± 5.0 6.0± 4.9 NS NS

(pieces week) condition 655
pupil
s)
G‐75


intervention (n 5.3 ± 5.3 5.4 ± 5.3 NS NS
with parental 1055
support pupil
s)
intervention (n 4.6 ±5.0 4.4 ± 4.7 NS NS

alone 685
pupil
s)
Soft drinks control (n 2.5 ± 2.2 2.6± 2.4 NS NS

(glasses day) condition 655
pupil
s)
intervention (n 3.1± 2.4 3.1 ±2.5 NS NS

with parental 1055
support pupil
s)

alone 685
pupil
s)
Water (glasses control (n 3.7 ± 2.6 4.0 ±2.8 NS NS

day21) condition 655
pupil
s)

with parental 1055
support pupil
G‐76


s)

alone 685
pupil
s)
Pre- and post- control (n 99 ± 39 95 ± 40 NS <0.001

test intake condition 392
levels (mean ^ pupil
SD) for fat s)
intake in girls
intervention (n 97 ± 38 85 ± 35 NS <.0001
with parental 432
support pupil
s)
intervention (n 108 ± 46 98 ± 40 NS <0.05

alone 108
pupil
s)
Pre- and post- control (n 38.7 ± 15.8 36.1 ± 15.5 NS <0.001

test intake condition 392
levels (mean ^ pupil
SD) for % s)
energy from fat
in girls intervention (n 37.5 ± 15.0 31.9 ± 13.6 NS <.0001
with parental 432
support pupil
s)
intervention (n 41.1 ± 16.8 36.6 ± 15.2 NS <0.05

108
G‐77


alone pupil
s)
Haerens, Dietary fat Control 84 Mean, 110 3 months NR

20079 intake SD, 42.2 after 50
(self-report) minute
(g/day) intervention:
mean, 107.3
SD, 41.5
Intervention 90 Mean, 120.9 3 months
SD, 48.7 after 50
minute
intervention:
mean, 108.2
SD, 43.9
students who SD, 50.1 after 50
had read the minute
intervention intervention:
message mean, 102
SD, 43.8
Dietary fat Control 67 Mean, 118.8 3 months NR
intake SD, 50.8 after 50
(technical- minute
vocational) intervention
mean, 110.5
SD, 47
SD, 51.6 after 50
minute
intervention
mean, 99.6
SD, 51.3
students who SD, 38.9 after 50
had read the minute
intervention intervention
message mean, 86.2
G‐78


SD, 39.3
Haerens, Cycling for Generic 543 76 (112) 105 (140) NS
10
2009 transportation Feedback
Tailored 511 78 (111) 110 (153) NS

feedback
Walking for Generic 543 75 (120) 98 (155) NS

transportation Feedback
Tailored 511 68 (119) 95 (170) NS

feedback
Walking in Generic 543 42 (96) 60 (139) NS

leisure time Feedback
Tailored 511 38 (99) 61 (156) NS

feedback
Total moderate Generic 543 618 (527) 642 (573) NS

to vigorous Feedback
activity
Tailored 511 604 (482) 642 (598) NS

feedback
Hurling, Hypothesis 1: Control 22 At 3 weeks At 10 weeks NS NS

11
2006 %of 70 43
G‐79


participants Intervention 25 At 3 weeks At 10 weeks NS NS
logging into 70 75
system after
10 week test
period
Hypothesis 2: Control 22 NS NS NS NS
change in
perception of Intervention 25 NS F(2, 57) 3.19; NS p < 0.05;
exercise as F(2, 57) 2.26, p=1.0.
boring; Too
much
effort
Hypothesis 3: Control 22 NS 0.6; .38 NS p < 0.05;

Change in
ratings of p <.01
Expectation; Intervention 25 Not clear 3.13; 3.6 NS p < 0.05;

satisfaction p <.01
with motivation
to exercise;
The mean Control 22 NS -0.05 NS (SE 0.37)

change (from
G‐80


the beginning
of the study
period Intervention 25 NS +0.64 NS (SE 0.39)
to 7 months
after the 10-
week
intervention) in
ratings of the
statement ‘‘I
am very
satisfied with
my current
level of
motivation to
do exercise’’
Hurling, MET min/week Control 30 9 weeks:

200712 mean, 4.0
SD, 4.1
Had access 47 9 weeks: 0.12
to the mean, 12
internet and SD, 3.1
mobile phone
Change in Control 30 3 weeks 9 weeks
weekly hours mean, -5.5
spent sitting SD, 3.5
(Met min/week Had access 47 3 weeks 9 weeks 0.03
leisure time) to internet mean, 4.1
and mobile SD, 2.6
phone
King, Total PA generic 161 55.5 (31.7) 53.6 (27.6) NS .005
(kcals/kg/hr) M health risk
G‐81


200613 (SD) appraisal
CD-ROM
174 58.4 (33.7) 64.6 (39.1) NS
Interactive
CD-ROM
Moderate PA generic 161 15.7 (19.1) 14.9 (17.8) NS .001

(kcals/kg/hr) M health risk
(SD) appraisal
CD-ROM
174 17.2 (20.6) 22.9 (26.4) NS
Interactive
CD-ROM
Kristal, Fat-related diet Control 604 2.30 ± 0.49 -0.00 ± 0.40 NS NS

14
2000 habit
Intervention 601 2.29 ± 0.49 -0.09 ± 0.38 NS NS
Fruit and Control 604 3.47 ± 1.41 0.14 ± 1.80 NS NS

vegetables
(svg/day) Intervention 601 3.62 ± 1.49 0.47 ± 1.83 NS NS
Lewis, median Standard NS NS 38 NS <.05

200815 number of Internet
logins
Motivationally NS NS 50 NS
-Tailored
Internet
5-itemWebsite Standard NS NS 11.64 NS <.001
G‐82


Quality Internet
Questionnaire Motivationally NS NS 16.76 NS

-Tailored
Internet
Low, Eating Control 14 Mean, 4.0 Post 8-9 month

16
2006 Disorder SD, 5.6 Intervention: follow-up:
Inventory (EDI) mean,5.0 mean, 5.5
-Drive for SD,4.6 SD, 5.7
Thinness Student 14 Mean, 2.5 Post 8-9 month NR
bodies with a SD, 6 Intervention: follow-up:
moderated mean,2.0 mean, 2.3
discussion SD,2.0 SD, 5.6
group
Un- 19 Mean, 2.3 Post 8-9 month
moderated SD, 3.4 Intervention: follow-up:
discussion mean,2.3 median, 1.2;
group SD,2.3 SD, 1.5
Program 14 Mean, 4 Post 8-9 month
alone SD, 5 Intervention: follow-up:
mean,3.7 mean, 3.7
SD,3.6 SD, 4.6
EDI- Bulimia Control 14 Mean, 1.2 Post 8-9 month
SD, 1.6 Intervention: follow-up
mean,1.1 mean, 2
SD, 1.0 SD, 1.9
Student 14 Mean, 1.4 Post 8-9 month p<0.05 for
bodies with a SD, 4.2 Intervention: follow-up pair wise
moderated mean,1.7 mean, 0.46 comparison
discussion SD, 1.7 SD, 1.9
group
Un- 19 Mean, 1.4 Post 8-9 month p<0.05 for
moderated SD, 2.2 Intervention: follow-up pair wise
discussion mean,0.85 mean, 0.42 comparison
group SD, 0.86 SD, 0.84
Program 14 Mean, 1.2 Post 8-9 month
G‐83


alone SD, 1.5 Intervention: follow-up
mean,0.47 mean, 1.3
SD, 0.53 SD, 1.6
EDI-Body Control 14 Mean, 9.4 Post 8-9 month p<0.05 for
Dissatisfaction SD, 8 Intervention: follow-up pair wise
mean,7.9 mean, 9.4 comparison
SD, 8.2 SD, 7.8
Student 14 Mean, 8.1 Post 8-9 month
bodies with a SD, 6.8 Intervention: follow-up
moderated mean,7.6 mean, 7
group
discussion mean, 5.9 mean, 5.2 comparison
group SD, 5.9 SD, 4.2
Program 14 Mean, 9 Post 8-9 month
alone SD, 6.7 Intervention: follow-up
mean,7.1 mean, 6.3
SD, 7.1 SD, 7.8
Weight and Control 14 Mean, 37 Post 8-9 month p<0.05 for
Shape SD, 22.3 Intervention: follow-up pair wise
Concerns mean,41.8 mean, 43.2 comparison
SD, 22.8 SD, 21.1
Student 14 Mean, 33.8 Post 8-9 month
bodies with a SD, 22.4 Intervention: follow-up
moderated mean, 32.2 mean, 29.9
group
discussion mean, 28.5 mean, 27.5 comparison
group SD, 29.3 SD, 14.5
Program 14 Mean, 38.3 Post 8-9 month
alone SD,17.0 Intervention: follow-up
mean, 38.2 mean, 34.6
SD, 26.7 SD, 16.7
Mangunkus Evaluation of Control 465 2-4 months: 0.035
G‐84


umo, Health mean, 4.1;
17 Behavior mode median, 4;
2007
(easy to use) range,
(Likert Scale) 4.0-5.0;
SD, 0.7
Internet 444 2-4 months: 0.035
Group mean, 4.2;
median, 4.0 ;
range,
4.0-5.0;
SD, 0.7
Evaluation of Control 418 2-4 months 0.005
Fruit Advice mean, 3.7
(pleasant) median, 4
(Likert Scale range,
3.0-4.0
SD, 0.7
Internet 381 2-4 months 0.005
mean, 3.8
median, 4
range,
3.0-4.0
SD, 0.7
Acceptability Control 417 2-4 months 0.001
(Was fruit mean, 3.3
advice median, 3
targeted to range,
you?) 3.0-4.0
SD, 1
Group mean, 3.5
median, 4
range,
3.0-4.0
SD, 0.9
Acceptability Control 417 2-4 months 0.004
(Did you enjoy mean, 3.2
it) median, 3
G‐85


range,
3.0-4.0
SD, 1
Internet 376 2-4 months BL, 0.004
Group mean, 3.4 time point 2,
median, 4 Liker Scale
range, 1-5
3.0-4.0
SD, 0.9
Quality of Control 417 2-4 months: 0.49
Intervention mean, 3.3:
(relevant) median, 4:
range,
3.0-4.0:
SD, 1
Internet 376 2-4 months: 0.49
Group mean, 3.5:
median, 4:
range,
3.0-4.0:
SD, 1
Quality of Control 417 2-4 months 0.003
Intervention mean, 3.8
(credible) median, 4
range,
4.0-4.0
SD, 0.8
Group mean, 3.6
median, 4
range,
3.0-4.0
SD, 0.9
Quality of Control 417 2-4 months 0.048
Intervention mean, 3.7
(useful) median, 4
range,
3.0-4.0
G‐86


SD, 0.9
mean, 3.6
median, 4
range,
3.0-4.0
SD, 0.9
Marcus, Physical Tailored print 86 Minutes of 6 months 12 months: Time point 2,
200718 activity per physical mean, 112.5 mean, 90 0.15
week activity per final time
week (using point, 0.74
PAR
interview)
Tailored 81 Minutes of 6 months 12 months: Time point 2,
internet physical mean, 120 mean, 90 0.15
activity per final time
PAR
interview)
Standard 82 Minutes of 6 months 12 months Time point 2,
internet physical mean, 90 mean, 80 0.15
PAR
interview)
Improvement Tailored print 86 6 months 12 months Time point 2,
in functional mean, 25.8 mean, 26.2 >.99
capacity SD, 6.8 SD, 6.9 final time
(estimated v02 point, 0.31
at 85% of
predicted
maximum
heart rate)
(ml/kg per
minute)
Tailored 81 6 months 12 months Time point 2,

internet mean, 26.5 mean, 26.1 >.99
G‐87


SD, 6.6 SD, 6.9 final time
point, 0.31
Standard 82 6 months 12 months Time point 2,
internet mean, 25.4 mean, 25.7 >.99
SD, 6.6 SD, 6 final time
point, 0.31
150 minutes of Tailored print 86 6 months, 12months, Time point 2,
physical (37.2) (32.6) 0.52
week (150 point, 0.45
minutes)
Tailored 81 6 months, 12months, Time point 2,

internet (44.4) (39.5) 0.52
final time
point, 0.45
Standard 82 6 month, 12 months, Time point 2,
internet (36.6) (30.5) 0.52
Final time
point, 0.45
Napolitano, Minutes Control 31 Mean, 80.86 1 month 3 month:
19 moderate SD, 77.8 mean, 96.82 mean, 82
2003
physical SD, 93.7 SD, 87.3
activity Internet 21 Mean, 68.79 1 month 3 month: P<0.05 at
intervention SD, 58.1 mean, 98.33 mean, 112 one month,
SD, 53.9 SD, 75.7 NS at 3
months
Minutes, Control 31 Mean, 87.57 1 month 3 month
walking SD, 177.4 mean, 83.79 mean, 68.39
SD, 121.1 SD, 85.2
Internet 21 Mean, 57.24 1 month 3 month p<0.001 at
intervention SD, 56.9 mean, 87.29 mean, 99.75
SD, 46 SD, 68.3
one month
and p<0.05
at three
months
G‐88


Stage of Control 31 1 month 3 month
change, Internet 21 1 month 3 month p<0.05) at
progression intervention
one month
and p<0.01
at three
months
Oenema, Intention to eat Control 102 Post- Diff between
20 less fat intervention: intervention
2001
mean, 0.29 and control
SD, 1.26 at post test,
p<0.01
Web based 96 Post- Diff between
tailored intervention: intervention
nutrition mean, 0.72 and control
education SD, 1.21 at post test,
p<0.01
Self-rated fat Control 102 Mean, -0.44 Post- Diff between
intake SD, 0.77 intervention intervention
compared to mean, -0.33 and control
others SD, 0.74 at post test,
p<0.01
Web based 96 Mean, -0.31 Post- Diff between
tailored SD, 0.7 intervention intervention
nutrition mean, -0.05 and control
p<0.01
Self-rated fruit Control 102 Mean, -0.51 Post- Diff between
intake SD, 0.98 intervention intervention
mean, -0.49 and control
p<0.01
Web based 96 Mean, -0.49 Post- Diff between
tailored SD, 0.91 intervention intervention
nutrition mean, -0.27 and control
p<0.01
Self rated fat Control 102 Post- Diff between
G‐89


intake Mean, -0.23 intervention intervention
SD, 0.77 mean, 0.01 and control
p<0.05
Tailored 96 Mean, 0.03 Post- Diff between
SD, 0.73 intervention intervention
mean, 0.17 and control
p<0.05
Self rated fruit Control 102 Mean, -0.34 Post- Diff between
intake SD, 1.01 intervention: intervention
compared to mean, -0.34 and control
others SD, 0.96 at post test,
p<0.05
Tailored 96 Mean, -0.31 Post- Diff between
SD, 0.93 intervention: intervention
mean, -0.16 and control
p<0.05
Self-rated Control 102 Mean, 0.37 Post- NS
vegetable SD, 0.73 intervention
intake mean, 0.3
SD, 0.76
Tailored 96 Mean, 0.2 Post- NS
SD, 0.71 intervention
mean, 0.08
SD, 0.74
Self-rated Control 102 Mean, 0.3 Post- NS
vegetable SD, 0.78 intervention
intake mean, 0.27
compared to SD, 0.72
other Tailored 96 Mean, 0.18 Post- NS
mean, 0.08
SD, 0.82
Oenema, Fat intake Control 232 Mean, 20.3 3 weeks after
200521 SD, 6.2 sending
intervention
G‐90


materials:
mean, 19.9
SD, 6.2
General 196 Mean, 3 weeks after
information 20.0SD, 5.9 sending
intervention
materials:
mean, 19.2
SD, 6.0
Tailored 188 Mean, 19.8 3 weeks after
Information SD, 6.1 sending
intervention
materials:
mean, 19.2
SD, 6.2
Vegetable Control 232 Mean, 1.9 3 weeks after
intake SD, 1.0 sending
intervention
materials
mean, 1.8
SD, 0.9
General 196 Mean, 1.8 3 weeks after
information SD, 0.8 sending
intervention
materials
Mean,1.7
SD,0.8
Information SD, 0.8 sending
intervention
materials
mean, 1.9
SD, 0.9
Fruit intake Control 232 Mean, 2.1 3 weeks after
SD, 1.4 sending
intervention
materials
mean,
G‐91


median, 2.0
range,
SD, 1.6
intervention
materials
mean, 2.0
SD, 1.2
intervention SD, 1.6 sending
intervention
materials
mean, 2.3
SD, 1.6
Fat self-rated Control 232 Mean, -0.11 3 weeks after
intervention
materials
mean, -0.18
SD, 0.73
General 196 Mean, -.16 3 weeks after
SD, 0.70 sending
intervention
materials
mean, -0.22
SD, 0.71
Tailored 188 Mean, -0.25 3 weeks after
SD,0.68 sending
intervention
materials
mean, -0.12
SD, 0.76
Vegetable self- Control 232 Mean, 0.42 3 weeks after
rated intake SD, 0.71 sending
intervention
materials:
mean, 0.37
G‐92


SD, 0.70
intervention
materials:
mean, 0.37
SD, 0.71
Tailored 188 Mean, 0..35 3 weeks after
SD, 0.67 sending
intervention
materials:
mean, 0.16
SD, 0.69
Fruit self-rated Control 232 Mean, -0.22 3 weeks after
intervention
materials
mean, -0.26
SD, 0.91
General 196 Mean, -0.26 3 weeks after
intervention
materials
mean, -0.16
SD, 0.89
intervention SD, 1.09 sending
intervention
materials
mean, -0.19
SD, 1.05
Fat Intention to Control 232 Mean, -0.21 3 weeks after
Change SD, 1.01 sending
intervention
materials
mean, -0.24
SD, 1.00
G‐93


SD, 0.95 sending
intervention
materials
mean, -0.13
SD, 0.99
Tailored 188 Mean, - 3 weeks after
0.23SD, 0.92 sending
intervention
materials
mean, 0.01
SD, 0.97
Vegetable Control 232 Mean, 0.85 3 weeks after
Intention to SD, -0.31 sending
Change intervention
materials:
mean, -0.26
SD, 0.89
SD, 0.83 sending
intervention
materials:
mean, -0.25
SD, 0.81
SD, 0.78 sending
intervention
materials:
mean, -0.04
SD, 0.93
Fruit Intention Control 232 Mean,-0.08 3 weeks after
to Change SD,0.93 sending
intervention
materials:
mean, -0.13
SD, 0.85
General 196 Mean,0.02 3 weeks after
SD,0.90 sending
G‐94


intervention
materials:
mean, -0.04
SD,0.92
Tailored 188 Mean,-0.10 3 weeks after
SD,0.88 sending
intervention
materials:
mean, -0.01
SD,1.01
Richardson, Total Steps LG 17 4,157 ± 6,279 ± 0.0142
200722 1,737 3,306
SG 13 5,171 ± 6,868 ± 0.1117

1,769 3,751
Bout Steps LG 17 286 ± 599 2,070 ± 0.0164*

2,814
SG 13 516 ± 801 2,616 ± 0.0196*

2,706
Change LG 17 2,122 ±
3,179
SG 13 1,783 ±
2,741
Smeets, Fat Control 1410 Mean, 18.7 Post test at 3 0.01

23 consumption SD, 6.2 month:
2007
(gm) mean, -1
SD, 0.05
Intervention 1417 Mean, 18.7 Post test at 3 0.05
group, SD, 6.2 month:
receiving one mean, -2.5
tailored letter SD, -0.05
G‐95


Fruit Control 1410 Mean, 2.7 Post test at 3 0.01
consumption SD, 1.7 month
(pieces/day) mean, -0.2
SD, 0.06
Intervention 1417 Mean, 2.7 Post test at 3 0.01
group, SD, 1.7 month
receiving one mean, 0.04
tailored letter SD, 0.06
Vegetable Control 1410 Mean, 139 Post test at 3 NR
consumption SD, 140 month
(gm/day) mean, -10.4
Intervention 1417 Mean, 139 Post test at 3

group, SD 140 month
receiving one mean, -0.48
tailored letter
Physical Control 1410 Mean, 5 Post test at 3
activity (action SD, 3.6 month
moments/wk) mean, -1.1
Intervention 1417 Mean, 5 Post test at 3 BL, time

group, SD, 3.6 month point 2,
receiving one mean, -0.7 Baseline
tailored letter mean and
SD are for
control and
treatment
groups
together. The
final time
point mean
and SD
reflect the
change in
action
moments per
day per day
(post-test
G‐96


minus
baseline).
Spittaels, Total MVPA No 104 201 (254) 233 (273) +32 NS
200724 scores=Moder Intervention
ate- to
vigorous- Website with 103 292 (285) 420 (337) +128 NS
intensity computer
physical tailored
activity for feedback
completers
Website 78 290 (319) 352 (357) +62 NS
without
computer
tailored
feedback
Spittaels, Increase in Control 141 Mean, 622 6 month:

200725 total physical SD, 462 mean, 708
activity SD, 514
On-line 116 Mean, 696 6 month: 0.001
tailored PA SD, 510 mean, 776
advice+ SD, 540
stage based
reinforcemen
t emails
On-line 122 Mean, 640 6 month:
tailored SD, 422 mean, 682
physical SD, 452
activity
advice
Increase in Control 141 Mean, 376 6 month
moderate to SD, 325 mean, 428
vigorous SD, 374
physical On-line 116 Mean, 438 6 month 0.05
activity tailored PA SD, 373 mean, 479
advice+ SD, 376
G‐97


stage based
reinforcemen
t emails
On-line 122 Mean, 362 6 month
physical SD, 310
activity
advice only
Increase in Control 141 Mean, 151 6 month
physical SD, 152 mean, 185
activity in SD, 161
leisure time On-line 116 Mean, 174 6 month .001
tailored PA SD, 191 mean, 211
advice+ SD, 220
stage based
reinforcemen
t emails
On-line 122 Mean, 154 6 month
physical SD, 188
activity
advice only
Tate, Dietary intake Control 54 Mean, 3 month: 6 month:
200626 (kcal/day) 1869.7 mean, mean,
SD, 778.9 1544.2 1603.5
SD,651.7 SD, 793.7
Tailored 40 Mean, 1911 3 month: 6 month: p<0.21 at 3
Computer- SD, 770.9 mean,1381. mean, months and
Automated 7 1488.7 p<0.28 at 6
Feedback SD,448.2 SD, 580.2 months
Human Email 52 Mean, 3 month: 6 month: p<0.21 at 3
Counseling 2042.6 mean,1468. mean, months and
(HC) SD, 875.6 2 1484.3 p<0.28 at 6
SD,449.1 SD, 574.3 months
Fat intake (% Control 54 Mean, 38.4, 3 month: 6 month
day) SD, 7.1 mean,36.0 mean, 37.3
SD,7.0 SD, 6.6
Tailored 40 Mean, 37.5 3 month: 6 month p<0.04 at 3
G‐98


Computer- SD, 6.1 mean,33.5 mean, 34 months and
Automated SD,4.9 SD, 6.5 p<0.004 at 6
Feedback months
Human Email 52 Mean,38.8 3 month: 6 month p<0.04 at 3
Counseling SD, 6.2 mean, 32.8 mean, 33.1 months and
(HC) SD,5.0 SD,4.9 p<0.004 at 6
months
Physical Control 54 Mean, 3 month: 6 month
activity 1188.7 mean, mean,
(kcal/week) SD, 1286.8 1335.8 1064.4
SD,1540 SD, 1139.5
Tailored 40 Mean, 3 month: 6 month p<0.08 at 3
Computer- 1210.9 mean,1525. mean, months and
Automated SD, 1234.9 1 1335.1 p<0.52 at 6
Feedback SD,1368.9 SD, 1410.1 months
Human Email 52 Mean, 3 month: 6 month p<0.08 at 3
Counseling 1283.9 mean, mean, months and
(HC) SD, 1969.3 1537.2 1377.1 p<0.52 at 6
SD,1113 SD, 1163.8 months
Vandelanott Increase Control 204 Minutes of 6 months:
27 Physical pa/week mean, 734
e, 2005
activity mean, 720 SD, 516
SD, 485
Sequential 180 Minutes of 6 months:
interactive pa/week mean, 727
computer mean, 514 SD, 492
tailored SD, 367
intervention
Simultaneous 189 Minutes of 6 months:
interactive pa/week mean, 705
computer mean, 532 SD, 519
tailored SD, 519
intervention
Decrease fat Control 195 Grams/week: 6 months
intake mean, 101 mean, 94
SD, 39 SD, 33
Sequential 194 Gram/week: 6 months
interactive mean, 110 mean, 85
G‐99


computer SD, 39 SD, 30
tailored
intervention
Simultaneous 176 Grams/week: 6 months
interactive mean, 118 mean, 85
computer SD, 43 SD, 28
tailored
intervention
Verheijden, Perceived Control 73 Mean score, Change after Change after BL, 0.87
28 support range, 1-7, 4 month 8 month: time point 2,
2004
higher score, mean, -0.08 mean, -0.07 0.29
better SD, final time
outcome point, 0.60
mean, 5.7
SD, 1.2
Web-Based 24 Mean score, Change after Change after BL, 0.87
Targeted range,1-7, 4 month 8 month: time point 2,
Nutrition higher score, mean, 0.11 mean, -0.17 0.29
Counseling better SD, final time
and Social outcome point, 0.60
Support mean, 5.7
SD, 1.3
Social network Control 73 Mean score, Change after Change after BL, 0.35
range,1-7, 4 month 8 month time point 2,
higher score, mean, 0.04 mean, 0.07 0.21
better SD, SD, final time
outcome: point, 0.49
mean, 3.5
SD, 0.5
Web-Based 24 Mean score, Change after Change after BL, 0.35
Targeted range,1-7, 4 month 8 month time point 2,
Nutrition higher score, mean, -.0.06 mean, 0.01 0.21
Counseling better SD, SD, final time
and Social outcome: point, 0.49
Support mean, 3.5
SD, 0.5
BMI ( kg/m2) Control 73 BMI, kg/m2 Change after Change after BL, 0.73
mean, 29.2 4 month 8 month time point 2,
G‐100


SD, 4.5 mean, -0.21 mean, -0.01 0.07
SD, SD, final time
point, 0.12
Web-Based 24 BMI, kg/m2 Change after Change after BL, 0.73
Targeted mean, 29.5 4 month 8 month time point 2,
Nutrition SD, 5.2 mean, 0.08 mean, -0.02 0.07
Counseling SD, SD, final time
and Social point, 0.12
Support
Systolic blood Control 73 Systolic Change after Change after BL, 0.42
pressure blood 4 month 8 month time point 2,
pressure mean, -2.1 mean, -5.2 0.46,
mean, 136 SD, SD, final time
SD, 18 point,
0.16
Web-Based 24 Systolic Change after Change after Time BL, 0.42

Targeted blood 4 month 8 month point 2, time point 2,
Nutrition pressure mean, -0.4 mean, -1.9 0.42 0.46
Counseling mean, 134 SD, time final time
and Social SD, 14 point 3, point,
Support 0.46 0.16
Diastolic blood Control 73 Diastolic Change after Change after BL, 0.61
pressure blood 4 month: 8 month: time point 2,
pressure: mean, -1.4 mean, -3.2 0.44
mean, 80 SD, SD, final time
SD, 11 point, 0.6
Web-Based 24 Diastolic Change after Change after BL, 0.61
Targeted blood 4 month: 8 month: time point 2,
Nutrition pressure: mean, -0.2 mean, -2.5 0.44
Counseling mean, 81 SD, SD, final time
and Social SD, 9 point, 0.6
Support
Total Control 73 Total Change after Change after BL, 0.56
cholesterol cholesterol 4 month 8 month time point 2,
mean, 5.4 mean, -0.06 mean, -0.11 0.41
SD, 1.2 SD, SD, final time
G‐101


point, 0.79
Web-Based 24 Total Change after Change after BL, 0.56
Targeted cholesterol 4 month 8 month time point 2,
Nutrition mean, 5.5 mean, 0.03 mean, -0.08 0.41
Counseling SD, 0.9 SD, SD, final time
and Social point, 0.79
Support
Wylie- Dietary Intake Work book 97 NS -397.9±55.3 NS NS
Rosett, J, (Kcal/d) only
29
2001
Computer 183 NS -283±41.8 NS NS
tailored
feedback
Computer 194 NS -323.6±43.1 NS NS

tailored
feedback
plus staff
consultation
Exercise Work book 97 NS 5.9±1.10 NS NS

(Blocks walked only
daily)
Computer 183 NS 5.1±0.79 NS NS
tailored
feedback

tailored
feedback
plus staff
consultation
Exercise (min Work book 97 NS 5.10±1.10 NS NS

walked
G‐102


continuously) only

tailored
feedback

tailored
feedback
plus staff
consultation
Weight (lb) Work book 97 NS -2.2±1.26 NS .003

only
Computer 183 NS -4.7±1.02 NS .003

tailored
feedback
computer 194 NS -7.4±1.15 NS .003

tailored
feedback
plus staff
consultation
BMI Work book 97 NS -0.4±0.21 NS .003

only
Computer 183 NS -0.8±0.17 NS .003

tailored
feedback
computer 194 NS -1.2±0.19 NS .003

tailored
G‐103


feedback
plus staff
consultation
Eating disorder
Winzelberg, Body shape Control 20 Mean, 104 Post 3months:
30 measure SD, 36 Intervention mean, 101
2000
mean, 107 SD, 44
SD, 39
Intervention 24 Mean, 118 Post 3months: p<0.01
group SD, 34 Intervention mean, 93
mean, 104 SD, 25
SD, 33
EDI-drive for Control 20 Mean, 24 Post 3months
thinness SD, 8 Intervention mean, 24.8
mean, 26 SD, 9.9
SD, 9.4
Intervention 24 Mean, 27.6 Post 3months p<.05
SD, 9.7 Intervention mean, 23.3
mean, 25.1 SD, 9.1
SD, 8.8
EDI-Bulimia Control 20 Mean, 14 Post 3months
mean, 14.8 SD, 6.7
SD, 6
Intervention 24 Mean, 15.9 Post 3months NS
mean, 14.1 SD, 5.7
SD, 7
EDE-Q Weight Control 20 Post 3months
Concerns Mean, 2.5 Intervention mean, 2.5
SD, 1.3 mean, 2.7 SD, 1.6
SD, 1.6
Intervention 24 Post 3months NS
Mean, 2.8 Intervention mean,
SD, 1.4 mean,2.5 median, 2.3
SD,1.3 range,
SD, 1.2
G‐104


EDE-Q Shape Control 20 Mean, 2.7 Post 3months:
Concern SD, 1.5 Intervention: mean, 2.6
mean, 3 SD, 1.7
SD, 1.6
Intervention 24 Mean, 3.3 Post 3months: NS
SD, 1.4 Intervention: mean, 2.5
mean, 2.8 SD, 1.3
SD, 1.3
Nutrition intervention
Bruge, Fat (points per Control 169 Fat points/ 3 weeks after p<0.05 for
199631 day) day receiving diff between
mean, 28 nutrition baseline and
SD, 5.3 letter: post test
mean, 27.2
SD, 5.5
Tailored 178 Fat points/ 3 weeks after p<.01
feedback day receiving between
mean, 29 nutrition baseline and
SD, 5 letter: post-test;
mean, 26.9 p<.01 for diff
SD, 4.9 between
tailored and
control group
Vegetables Control 169 Servings/day: 3 weeks after p<0.05 for
(servings per mean, 1 receiving diff between
day) SD, 0.31 nutrition letter baseline and
mean, 1.06 post test
SD, 0.37
Tailored 178 Mean, 1.03 3 weeks after NS
feedback SD, 0.36 receiving
nutrition letter
mean, 1.07
SD, 0.36
Fruit (servings Control 169 Servings/ day 3 weeks after None
per day) mean, 1.61 receiving
SD, 1.14 nutrition letter
mean, 1.57
SD, 1.19
G‐105


178 Servings/ day 3 weeks after None
mean, 1.49 receiving
SD, 1 nutrition letter
mean, 1.57
SD, 0.96
Positive Control 169 3 weeks after
attitude to receiving
increasing dietary
vegetables information ,
and fruits .11
Tailored 178 3 weeks after p<.01 for diff

feedback receiving between
dietary tailored and
information, control group
.39
Silk, Likeability of Pamphlet 57 Likeability 10-12days: p<0.05
32
2008 learning was mean, 3.99
materials measured SD, 0.66
(hypothesis 1) using 9 items
[authors on a 5-point
identify 3 Likert-type
subscales -- scale.
attention, mean, no
understanding, measure
intention] SD,
Website 51 Likeability 10-12days: p<0.05
was mean, 4.29
measured SD, 0.45
using 9 items
on a 5-point
Likert-type
scale.
Video game 47 Likeability 10-12days: p<0.05
was mean, 4.06
measured SD, 0.66
using 9 items
G‐106


on a 5-point
Likert-type
scale.
Nutrition Pamphlet 57 Knowledge 10-12days p<.05
literacy scores questions mean, 24.75
(hypothesis 2) were based SD, 4.76
[authors on the
identify 6 EFNEP
subscales: My Evaluation
Pyramid, Food and
groups, Food Reporting
servings, System
Serving size, developed by
Food safety, USDA for
Food cost] EFNEP at
the federal
level (33
items)
Website 51 Knowledge 10-12days p<.05
questions mean, 25.59
were based SD, 3.56
on the
EFNEP
Evaluation
and
Reporting
System
developed by
USDA for
EFNEP at
the federal
level (33
items)
Video game 47 Knowledge 10-12days p<.05
questions mean, 23.17
were based SD, 4.95
on the
EFNEP
G‐107


Evaluation
and
Reporting
System
developed by
USDA for
EFNEP at
the federal
level (33
(Items)
Overweight and binge eating
Jones, BMI Control 43 Mean, 30.64 Post 16weeks:
2008
33 (kg/m2) SD, 5.97 Treatment mean, 31.17
mean, 29.99 SD, 6.33
SD, 5.92
SB2-BED 44 Mean, 30.58 Post 16weeks: p<.001
SD, 4.9 Treatment mean, 29.76
mean, 28.76 SD, 5.34
SD, 4.72
BMIzScore Control 43 Mean, 1.79 Post 16weeks
mean, 1.68 SD, 0.57
SD, 0.54
SB2-BED 44 Mean, 1.81 Post 16weeks p<.001
mean, 1.56 SD, 0.62
SD, 0.59
Binge eating Control 43 No. of Post 16weeks
(OBEs and episodes Treatment mean, 2.74
SBEs) mean, 8.42 mean, 6.98 SD, 8.6
SD, 18.74 SD, 17.55
SB2-BED 44 No. of Post 16weeks p<.05
episodes Treatment mean, 2.29
mean, 15.16 mean, 0.95 SD, 7.67
SD, 20.78 SD, 3.88
Binge eating Control 43 No. of Post 16weeks
(OOEs) episodes Treatment mean, 1.07
mean, 7.53 mean, 2.34 SD, 2.80
G‐108


SD, 14.28 SD, 5.25
SB2-BED 44 No. of Post 16weeks NS
episodes Treatment mean, 2.16
mean, 7.89 mean, 2.05 SD, 9.33
SD, 14.28 SD, 6.98
Weight and Control 43 Score Post 16weeks
shape mean, 1.35 Treatment mean, 1.14
concerns SD, 0.92 mean, 1.27 SD, 0.72
SD, 0.78
SB2-BED 44 Score: Post 16weeks p<0.05
mean, 1.3 Treatment mean, 0.81
SD, 0.80 mean,1.05 SD, 0.67
SD, 0.64
Dietary fat Control 43 Score: Post 16weeks:
intake mean, 22.06 Treatment: mean, 17.33
SD, 10.73 mean, 20.05 SD, 7.57
SD, 7.49
SB2-BED 44 Score: Post 16weeks: NS
mean, 24.54 Treatment: mean, 18.25
SD, 8.63 mean, 18.88 SD, 6.95
SD, 6.56
Depressed Control 43 Score: Post 16weeks
mood mean, 15.63 Treatment mean, 10.49
SD, 10.33 mean, 12.57 SD, 11.21
SD, 10.10
SB2-BED 44 Score: Post 16weeks NS
mean, 14.26 Treatment mean, 12.42
SD, 9.43 mean, 9.63 SD, 11.59
SD, 8.30
NS = Not Significant, BL = baseline, SD =Standard Deviation, BMI= Body Mass Index
Reference List
G‐109

1 Adachi Y, Sato C, Yamatsu K, Ito S, Adachi K, Yamagami T. A randomized controlled trial on the long-term effects of a 1-month behavioral weight control
program assisted by computer tailored advice. Behav Res Ther 2007; 45(3):459-70.
2 Anderson ES, Winett RA, Wojcik JR, Winett SG, Bowden T. A computerized social cognitive intervention for nutrition behavior: Direct and mediated
effects on fat, fiber, fruits, and vegetables, self-efficacy, and outcome expectations among food shoppers. 2001; 23(2):88-100.
3 Brug J, Glanz K, Van Assema P, Kok G, Van Breukelen GJP. The Impact of Computer-Tailored Feedback and Iterative Feedback on Fat, Fruit, and
Vegetable Intake. 1998; 25(4):517-31.
4 Brug J, Steenhuis I, Van Assema P, Glanz K, De Vries H. Computer-tailored nutrition education: Differences between two interventions. 1999; 14(2):249-
56.
5 Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: The effectiveness of tailored messages in
primary care settings. 1994; 84(5):783-7.
6 Campbell MK, Honess-Morreale L, Farrell D, Carbone E, Brasure M. A tailored multimedia nutrition education pilot program for low-income women
receiving food assistance. 1999; 14(2):257-67.
7 Campbell MK, Carbone E, Honess-Morreale L, Heisler-MacKinnon J, Demissie S, Farrell D. Randomized trial of a tailored nutrition education CD-ROM
program for women receiving food assistance. 2004; 36(2):58-66.
8 Haerens L, De Bourdeaudhuij I, Maes L, Vereecken C, Brug J, Deforche B. The effects of a middle-school healthy eating intervention on adolescents' fat
and fruit intake and soft drinks consumption. 2007; 10(5):443-9.
9 Haerens L, Deforche B, Maes L, Brug J, Vandelanotte C, De Bourdeaudhuij I. A computer-tailored dietary fat intake intervention for adolescents: results of
10 Haerens L, Maes L, Vereecken C, De Henauw S, Moreno L, De Bourdeaudhuij I. Effectiveness of a computer tailored physical activity intervention in
adolescents compared to a generic advice. Patient Educ Couns 2009.
11 Hurling R, Fairley BW, Dias MB. Internet-based exercise intervention systems: Are more interactive designs better? 2006; 21(6):757-72.
12 Hurling R, Catt M, Boni MD et al. Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled
trial. J Med Internet Res 2007; 9(2):e7.
G‐110

13 King DK, Estabrooks PA, Strycker LA, Toobert DJ, Bull SS, Glasgow RE. Outcomes of a multifaceted physical activity regimen as part of a diabetes self-
management intervention. 2006; 31(2):128-37.
14 Kristal AR, Curry SJ, Shattuck AL, Feng Z, Li S. A randomized trial of a tailored, self-help dietary intervention: The puget sound eating patterns study.
2000; 31(4):380-9.
15 Lewis B, Williams D, Dunsiger S et al. User attitudes towards physical activity websites in a randomized controlled trial. Prev Med 2008; 47(5):508-13.
16 Low KG, Charanasomboon S, Lesser J et al. Effectiveness of a computer-based interactive eating disorders prevention program at long-term follow-up. Eat
Disord 2006; 14(1):17-30.
17 Mangunkusumo R, Brug J, Duisterhout J, de Koning H, Raat H. Feasibility, acceptability, and quality of Internet-administered adolescent health promotion
in a preventive-care setting. Health Educ Res 2007; 22(1):1-13.
18 Marcus BH, Lewis BA, Williams DM et al. A comparison of Internet and print-based physical activity interventions. Arch Intern Med 2007; 167(9):944-9.
19 Napolitano MA, Fotheringham M, Tate D et al. Evaluation of an internet-based physical activity intervention: a preliminary investigation. Ann Behav Med
2003; 25(2):92-9.
20 Oenema A, Brug J, Lechner L. Web-based tailored nutrition education: results of a randomized controlled trial. Health Educ Res 2001; 16(6):647-60.
21 Oenema A, Tan F, Brug J. Short-term efficacy of a web-based computer-tailored nutrition intervention: main effects and mediators. Ann Behav Med 2005;
29(1):54-63.
22 Richardson CR, Mehari KS, McIntyre LG et al. A randomized trial comparing structured and lifestyle goals in an internet-mediated walking program for
people with type 2 diabetes. Int J Behav Nutr Phys Act 2007; 4:59.
23 Smeets T, Kremers SP, Brug J, de Vries H. Effects of tailored feedback on multiple health behaviors. Ann Behav Med 2007; 33(2):117-23.
24 Spittaels H, De Bourdeaudhuij I, Vandelanotte C. Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the
general population. 2007; 44(3):209-17.
25 Spittaels H, De Bourdeaudhuij I, Brug J, Vandelanotte C. Effectiveness of an online computer-tailored physical activity intervention in a real-life setting.
Health Educ Res 2007; 22(3):385-96.
G‐111

26 Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in
an Internet weight loss program. Arch Intern Med 2006; 166(15):1620-5.
27 Vandelanotte C, De Bourdeaudhuij I, Sallis JF, Spittaels H, Brug J. Efficacy of sequential or simultaneous interactive computer-tailored interventions for
increasing physical activity and decreasing fat intake. Ann Behav Med 2005; 29(2):138-46.
28 Verheijden M, Bakx JC, Akkermans R et al. Web-based targeted nutrition counselling and social support for patients at increased cardiovascular risk in
general practice: randomized controlled trial. J Med Internet Res 2004; 6(4):e44.
29 Wylie-Rosett J, Swencionis C, Ginsberg M et al. Computerized weight loss intervention optimizes staff time: The clinical and cost results of a controlled
clinical trial conducted in a managed care setting. 2001; 101(10):1155-62.
30 Winzelberg AJ, Eppstein D, Eldredge KL et al. Effectiveness of an Internet-based program for reducing risk factors for eating disorders. J Consult Clin
Psychol 2000; 68(2):346-50.
31 Brug J, Steenhuis I, Van Assema P, De Vries H. The impact of a computer-tailored nutrition intervention. 1996; 25(3):236-42.
32 Silk KJ, Sherry J, Winn B, Keesecker N, Horodynski MA, Sayir A. Increasing nutrition literacy: testing the effectiveness of print, web site, and game
modalities. J Nutr Educ Behav 2008; 40(1):3-10.
33 Jones M, Luce KH, Osborne MI et al. Randomized, controlled trial of an internet-facilitated intervention for reducing binge eating and overweight in
adolescents. Pediatrics 2008; 121(3):453-62.
G‐112

Evidence table 11. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in alcohol abuse (KQ1b)
Year data
Consumer CHI collected/
Author, under Application duration of Exclusion Jadad
year study type Location intervention Inclusion criteria criteria Control Intervention score
Alcohol Abuse
Cunningham, Individuals Interactive Home/ 2 yr After After 1.5
20051 interested consumer residence intervention, intervention,
in their own website, did not received
health care receive additional self-
additional help materials
self-help by postal mail
information
by postal
mail
Hester, Individuals Personalized Home/ NS <21 yr old, Minimum Current alcohol Delayed 2
20052 interested health risk residence score of 8 on treatment, treatment
in their own assessment Alcohol Use Severe
health care tool Disorders Inventory uncontrolled
Test, thought
At least 8th grade disorder,
reading level, Presence of a
Available and willing medical
significant other to condition for
corroborate self- which alcohol
report of drinking use would be
contraindicated
Kypri , 19993 Individuals Personalized Home/ 2002/ 17-26 yr old, Score Leaflet on Web-based 4
interested health risk residence NS of 8 or more on the health assessment
in their own assessment Alcohol Use effects of and
health care tool Disorders alcohol personalized
Identification Test, feedback on
Consuming more their drinking
than 4/6 standard
drinks (F/M) on one
more occasions in
the preceding 4
weeks
Lieberman, Individuals Interactive NS 18 months Text website Multimedia -0.5
20064 interested consumer website
in their own website
health care
Neighbors, Individuals Interactive Remote NS At least one heavy No Personalized 1
interested consumer location: drinking episode at intervention normative
G-113
Evidence table 11. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in alcohol abuse (KQ1b) (continued)
Year data
20045 in their own website "Controlled one sitting in the feedback
health care setting on previous month
campus"
Riper, Adult Web-based Data from NS Men who were Insufficient Control The
6
2008 alcohol self help other RCT drinking more than alcohol use, condition (an experimental
drinkers intervention 21 standard units above age 65, online condition
per week, women alcohol-related psycho participants
who were drinking medication, educational access to web-
over 14 units per professional brochure on based self help
week, age 18-65, help, alcohol use intervention
access to the in other alcohol that could be without
internet, no previous study; read in 10 therapist
professional help for incomplete minutes)
problem drinking data,
non-response,
in same
household
Riper, Individuals Interactive NS Yr 2003 18–65 yr, Control Experimental 2
20087 interested consumer Men were selected condition condition
in their own website who were drinking
health care either more than 21
units per week
(excessive drinking)
or 6 or more units at
least 1 day per week
for the past 3
months (hazardous
drinking).
Women were
included if they
drank over 14 units
a week or 4 or more
units at least 1 day a
week for the past
3months.
Access to the
internet.
Not receiving
professional help for
problem drinking at
G-114
Evidence table 11. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in alcohol abuse (KQ1b) (continued)
Year data
the start of the
study.
Yr = year, NS= Not Specified
Reference List
1 Cunningham JA, Humphreys K, Koski-Jannes A, Cordingley J. Internet and paper self-help materials for problem drinking: is there an additive effect?
Addict Behav 2005; 30(8):1517-23.
2 Hester RK, Squires DD, Delaney HD. The Drinker's Check-up: 12-month outcomes of a controlled clinical trial of a stand-alone software program for
problem drinkers. J Subst Abuse Treat 2005; 28(2):159-69.
3 Kypri K, Saunders JB, Williams SM et al. Web-based screening and brief intervention for hazardous drinking: a double-blind randomized controlled trial.
Addiction 2004; 99(11):1410-7.
4 Lieberman DZ. Effects of a personified guide on adherence to an online program for alcohol abusers. Cyberpsychol Behav 2006; 9(5):603-7.
5 Neighbors C, Larimer ME, Lewis MA. Targeting misperceptions of descriptive drinking norms: efficacy of a computer-delivered personalized normative
feedback intervention. J Consult Clin Psychol 2004; 72(3):434-47.
6 Riper H, Kramer J, Keuken M, Smit F, Schippers G, Cuijpers P. Predicting successful treatment outcome of web-based self-help for problem drinkers:
secondary analysis from a randomized controlled trial. J Med Internet Res 2008; 10(4):e46.
7 Riper H, Kramer J, Smit F, Conijn B, Schippers G, Cuijpers P. Web-based self-help for problem drinkers: a pragmatic randomized trial. Addiction 2008;
103(2):218-27.
G-115
Evidence Table 12. Description of consumer characteristics in addressing impact of CHI applications on intermediate outcomes in alcohol abuse
Control
Author, Gender, Marital Other
year Interventions Age Race, n (%) Income Education, n (%) SES n (%) Status characteristics
alcohol abuse
Cunningham , After Baseline characteristics not reported
20051 intervention,
did not receive
additional self-
help
information by
postal mail
Internet plus
book
Hester , Delayed Baseline characteristics not reported
20052 treatment
DCU/
Immediate
treatment
group
Kypri , 19993 Leaflet on Mean, 20.4 NS NS NS NR AUDIT score,
health effects SD, 1.8 mean, 16.6
of alcohol SD, 6
Web-based Mean, 19.9 NS NS NS NR AUDIT score,
assessment SD, 1.4 mean, 16.6
and SD, 6
personalized
feedback on
their drinking
Lieberman, Text website Mean, 37.2 White non NS NS NR F, (37.2) Age of first drink,
4 SD, 11.8 Hispanic, (87) mean, 16.4
2006
Black non- SD, 3.9
Hispanic, (1.7)
Latino/Hispanic, Drinks per week,
(7) mean, 34.3
API, (2.3) SD, 31.6
AIAN , (2.3)
Other, 6.5 AUDIT score,
mean, 17
SD, 8.8
Multimedia Mean, 36 White non- NS NS NR F, (31) Age of first drink,
website SD, 12.1 Hispanic, (86.8) mean, 17.4
Black non- SD, 5.5
G-116
Evidence Table 12. Description of consumer characteristics in addressing impact of CHI applications on intermediate outcomes in alcohol abuse (continued)
Control
Hispanic, (1.6)
Latino/Hispanic, Drinks per week,
(4.1) mean, 32.4
API, (4.1) SD, 50.8
AIAN, (2.5)
No response, (5.0 ) AUDIT score,
mean, 15.7
SD, 8.4
Neighbors , No intervention NS NS NS NS NR M, 54
5 F, 72
2004
Intervention NS NS NS NS NR M, 50
(personalized F, 76
normative
feedback)
Riper, Control: Control: NS Paid Control low 38 (29.0) NS F 64(48.9) High Internet
6
2008 alcohol mean 46.2 employ High 93 (71.0) competence100
information SD,9.2 ment (76.3)
brochure control: High treatment
96 expectancy 66
(73.3) (49.6)
Weekly alcohol
intake 43.5 (22.3)
Moderate problem
drinking74 (56.5)
Sever problem
drinking 57 (43.5)
Prior professional
help for problem
drinking 15 (11.5)
Contemplation
stage 115 (87.8)
Alcohol moderation
as goal 123 (93.9)
Living with a
partner 71 (54.2)
Intervention: Experiment NS Paid Low 41 (31.5) NS F 64(49.2) High Internet
G-117
Control
drinking less al : mean employ High 89 (68.5) competence 104
(free-access, 45.9 ment (80.0)
Web-based SD,8.9 control: High treatment
self-help 96 expectancy 61
intervention (73.3) (46.9)
without Weekly alcohol
therapist intake 43.7 (21.0)
guidance. Moderate problem
drinking 74 (56.9)
Sever problem
drinking 56 (43.1)
Prior professional
help for problem
drinking18 (13.8)
Contemplation
stage 116 (89.2)
Alcohol moderation
as goal 120 (92.3)
Living with a
partner 71 (54.2)
75 (57.7)
Riper, 20087 Control Mean, 46.2 NS NS Unskilled, 38 (29.0) NR F, 64 Problem drinking,

condition (PBA) SD, 9.2 Vocational, 55 (42.0) (48.9) 131 (100)
Academic, 38 (29.0) Excessive drinking,
128 (97.7)
Experimental Mean, 45.9 NS NS Unskilled, 41 (31.5) NR F, 64 Problem drinking,
condition (DL) SD, 8.9 Vocational, 52 (40.0) (49.2) 130 (100)
Academic, 37 (28.5) Excessive drinking,
125 (96.2)
NR= Not Reported, NS= Not specified, SD= Standard Deviation, SES= Socioeconomic Status, AIAN= American Indian/Alaska Native, API = Asian/Pacific Islander
F = female, M = Male
G-118
Reference List
Addict Behav 2005; 30(8):1517-23.
Addiction 2004; 99(11):1410-7.
103(2):218-27.
G-119
Evidence table 13. All outcomes in studies addressing the impact of CHI applications on intermediate outcomes in alcohol abuse (KQ1b)
Control Measure at
Author, Measure Measure at Measure at final time Ratios at
year Outcomes Intervention n at BL time point 2 time point 3 point time points Significance
Alcohol Abuse
Cunningham, Mean drinks Internet 29 Mean, 21 3 months
20051 per typical alone SD, 16.6 mean, 17.4
week SD, 17.7
Internet plus 19 Mean, 29.1 3 months p<0.05
self help book SD, 23.2 mean, 18.4
SD, 25.8
Mean AUDIT Internet 29 Mean, 15.6 3 months
test score alone SD, 8.9 mean, 12.6
SD, 7.8
book SD, 10.3 mean, 11.9
SD, 9.9
Mean # of Internet alone 29 Mean, 2.4 3 months
alcohol SD, 1.9 Mean, 1.9
consequences SD, 1.6
book SD, 1.8 mean, 1.5
SD, 1.6
Hester , 20052 Average drinks DCU/4 week 21 Mean, 5.64 4 weeks 8 weeks 12 months P 0.008
per day Delayed SD, 4.66 mean, 4.13 mean, 3.56 median, 2.5
treatment SD, 2.61 SD, 2.8 SD, 2.58
group
DCU/ 29 Mean, 5.69 4 weeks 8 weeks 12 months P 0.002
Immediate SD, 5.44 mean, 2.71 mean, 2.31 mean, 2.07
group
Drinks per DCU/4 week 21 Mean, 5.57 4 weeks 8 weeks 12 months NR
drinking day Delayed SD, 2.55 mean, 5.66 mean, 4.86 mean, 4.14
group
DCU/Immedia 29 Mean, 8.84 4 weeks 8 weeks 12 months NR
te treatment SD, 6.36 mean, 5.64 mean, 6.66 mean, 5.5
group SD, 4.09 SD, 6.12 SD, 4.63
Average peak DCU/4 week 21 Mean, 0.161 4 weeks 8 weeks 12 months P 0.003
BAC Delayed SD, 0.132 mean, 0.149 mean, 0.1 mean, 0.073
group
DCU/ 29 Mean, 0.174 4 weeks 8 weeks 12 months P 0.001
G‐120

Evidence table 13. All outcomes in studies addressing the impact of CHI applications on intermediate outcomes in alcohol abuse (KQ1b) (continued)
Control Measure at
Immediate SD, 0.107 mean, 0.096 mean, 0.118 mean, 0.078
group
Kypri , 19993 Drinking Control 47 N of drinking days 6 weeks 6 months:
frequency in last 2 weeks median, 4 median, 4
range, 0-13 range, 0-14
Computerized 47 N of drinking days 6 weeks 6 months NR
assessment in last 2 weeks median, 3 median, 3
and range, 0-9 range, 0-8
behavioral
intervention
Lieberman, Number of Control NS Number of After
4 modules modules (1-4) completing
2006
completed each of 4
modules
mean, 3.69
Multimedia NS After 0.01
completing
each of 4
modules
mean, 3.9
Perceived Control Helpfulness After
helpfulness of scores (rating the completing
the modules 4 modules) each of 4
modules
mean, 12.1
Multimedia Helpfulness After 0.74
scores (rating the completing
4 modules) each of 4
modules
mean, 12.2
Neighbors , Effect size in Control 126 Effect Size 3 months 6 months
5 perceived mean, .17 mean, .2
2004
norms Computerized 126 Effect size 3 months 6 months NR
normative mean, .46 mean, .48
feedback
Effect size in Control 126 Effect Size 3 months 6 months
reduction in mean, .05 mean, .03
alcohol Computerized 126 Effect Size 3 months 6 months p<0.01
G‐121

Control Measure at
consumption normative mean, .24 mean, .22
feedback
Effect size in Control 126 Effect Size 3 months 6 months
reduction in
alcohol Computerized 126 Effect Size 3 months 6 months
consumption normative
feedback
Riper, Mean alcohol Control: 131 Follow up at 6 Follow up at NS
20086 consumption alcohol month n 81 12 month n
difference information (61.8) 92(70.2)
between brochure
baseline and Loss to follow-up Loss to
6months and at 6 month n 50 follow up at
12month follow (38.2) 12 month n
up period. 39(29.8)
Intervention: 130 Follow up at 6 Follow up at NS Females
drinking month n 70 12 month n displayed
less(free- 71(54.6)
access, Web- (53.8) modest
based self- predictive
help power at 6
intervention month P .05
without
therapist
G‐122

Control Measure at
guidance. Loss to follow-up Loss to
at 6 month n 60 follow up at
(46.2) 12 month n at 12 month
59(45.4) P .045
With higher
levels of
education
modest
predictive
power P .01
Riper, 20087 Weekly alcohol Control 81 Weekly alcohol 6months Difference in P 0.001
consumption intake in std units mean, 39.2 means,10.6
(second mean, 43.5 (95) (CI,4.33-
outcomes) SD, 22.3 16.94)
Intervention 70 Weekly alcohol 6months
condition DL intake in std units mean, 28.7
mean, 43.7
SD, 21
SD = Standard deviation, BL = baseline, CI = confidence interval, DCU = Drinker’s Check-up, NR = Not reported

G‐123

Reference List
Addict Behav 2005; 30(8):1517-23.
Addiction 2004; 99(11):1410-7.
103(2):218-27.
G‐124

Evidence Table 14. Description of RCTs addressing impact of CHI applications on intermediate outcomes in smoking (KQ1b)
Year data
Smoking
An, 20081 Individuals Interactive University of 2004 ≥18 yr, Control RealU 2
interested consumer Minnesota Smoked cigarettes group intervention
in their own website internet in the past 30 days, group
health care health indicated that they
screening intended to be in
school for the next
two semesters
Brendryen, Smokers in Internet and Online 2006 / 18 years or older, NR Self-help Happy Ending
2008 2 Norway cell phone February Willing to quit on booklet program (HE)
2006 to March 6, 2006,
March, 2007 currently
smoking five
cigarettes or more a
day, willing to quit
without using NRT,
owning a
mobile phone,
owning a
Norwegian-
registered phone
number and postal
address, and having
daily access to the
Internet and email.
Curry, Random Computer Residence NS / 21 Self-identified No treatment Booklet (self-
3
1995 sample of generated months smoker help booklet)
group tailored Feedback
health feedback (self-help
cooperativ booklet +
e enrollees personalized
feedback)
Phone
(Booklet +
Feedback +
Counselor
phone call)
Dijkstra, Students Information Laboratory NR / One Student who is a NR Standard Personalizatio
4
2005 who are at university session smoker information n
smokers
G-125
Evidence Table 14. Description of RCTs addressing impact of CHI applications on intermediate outcomes in smoking (KQ1b) (continued)
Year data
Adaptation
Feedback
Hang, Daily SMS University 2007 / Daily smoker, use NR No 1 SMS per
2009 5 smoker messaging August to SMS (text intervention week
December messaging) at least
weekly 3 SMS per
week
Japuntich, Individuals Interactive Home/ Recruitment ≥18 yr, Current bupropion CHESS 2
6
2006 interested consumer residence took place Smoke at least 10 depression, plus intervention
in their own website from cigarettes per day, current use of counseling with
health care October Have a traditional psychiatric alone bupropion
2001 to July telephone line, medication,
2002. Literate in English medical conditions
contraindicating
bupropion SR
(e.g., history of
seizure disorder),
current use of a
smoking cessation
product or
treatment,
Being pregnant or
likely to become
pregnant during
the treatment
phase of the study
Pattens, Individuals Interactive Clinician March 2000 11-18 yr , Homeless, Brief office Stomp Out 1
20067 interested consumer office to November gave written consent Alcohol or drug intervention Smokes
in their own website 2003 or received consent abuse in the last 3
health from months
care, parent/guardian,
adolescent 18 yr,
smokers Smoked 10 or more
cigarettes in last 30
days,
Cigarettes were
primary tobacco
product used,
Willing and able to
G-126
Year data
complete treatment
assessment visits
Prochaska, Volunteer Tailored Residence NS / 18 Smokers who ALA + TTT
8
1993 smokers in manuals months responded to (standard (individualized
Rhode and advertisement self-help manual)
Island computer manual) ITT
reports (interactive
computer
reports)
PITT
(personalized
counselor
calls + ITT
TTT)
Prokhorov, Students in Interactive High school NS / 4 years 10th grade Clearing the ASPIRE
9
2008 culturally CD-ROM Speaks, reads and Air self-help Interactive
diverse writes English booklet CD-ROM
high
schools
Schiffman, Individuals Computer Home/ 1996/ NS >18 yr, User Guide Committed 2.5
200010 interested tailored residence Current cigarette only Quitter
in their own mailings via smoker, Program
health care computer Purchased 2 or 4 mg
assisted nicotine prolacrilex
automated gum,
telephone Were attempting to
interviews quit smoking
cigarettes,
Target quit date was
within 7 days of
enrollment,
Agreed to be
contacted at follow
up at 6 and 12
weeks
Schumann, Smokers Computer Residence 2002 – 2004 Provided written No Feedback
11
2006 drawn from generated / 24 months informed consent intervention letters
representat tailored and said yes to a
ive feedback question about
population currently smoking
G-127
Year data
of 20-79
year olds
living in
Western
Pomeania,
GERMANY
Schumann, Individuals Letters NS Started in 20-79 yr, Assessment- Computer- 2.5
12
2008 interested entered into April 2002 Currently smoke only control tailored TTM-
in their own a system cigarettes, group based
health care with PHI Currently smoke intervention
and cigars or cigarillos, group
generating Currently a pipe
tailored smoker
information
for the
consumer
Severson, Individuals Interactive Online NS At least 18 yr old, Text-based Tailored 2
13
2008 interested consumer Male, website web-based
in their own website A resident of the US (Basic intervention
health care or Canada, Condition) (Enhanced
E-mail address Condition)
checked at least
weekly,
any ST user (defined
as having used ST
for at least 1 year
and used at least at
in a week),
and willing to
provide his or her
name,
mailing address,
and phone number
Strecher, Adult Computer Residence Study 1: 40-65 years old, Standardize Tailored letter
1994 14 cigarette generated 1990 / 4 seen by family d generic from
Study 1 smokers in tailored months physician in last 6 letter individual’s
North feedback months, telephone physician
Carolina available and
working, not sharing
household with other
G-128
Year data
subject, mentally
and physically
capable of being
interviewed.
Strecher, Callers to 18 yrs or older,
15
2005 NCI CIS English as a
call centers primary language,
smoked at least five
cigarettes per day,
interested in quitting,
not currently in
another cessation
program, not
currently
undergoing or
planning cancer
treatment
Strecher, Individuals Interactive NS ≥18 yr, -1
16 interested consumer Target quit date
2005
in their own website within 7 days,
health care Valid email address,
Internet access,
Smoke more than 10
cig/day
Purchased NiQuitin
CQ 21 mg,
Agreed to contact for
FU email and
questionnaire at 6
and 12 weeks
Strecher, Individuals Interactive Home/ NS ≥ 18 yr, Non-tailored Tailored web- 0.5
17
2006 interested consumer residence Smokers in the Web-based based
in their own website United Kingdom and cessation smoking
health care Republic of Ireland material cessation (CQ
who purchased PLAN)
NiQuitin CQ 21-mg
patch and connected
to a Web site to
enroll for free
behavioral support
G-129
Year data
materials,
Had a target quit
date that was within
seven days from the
enrollment date,
Provided a valid e-
mail address and
had Internet access
for the duration of
the study,
Were attempting to
quit smoking
cigarettes (i.e.,
not smokeless
tobacco),
Had been smoking
more than 10
cigarettes per day,
had purchased
NiQuitin CQ 21 mg
(21 mg of nicotine;
indicated for those
who smoke at least
10 cigarettes per
day),
Agreed to be
contacted for follow-
up e-mail and Web-
based
questionnaires at 6
and 12 weeks
Strecher, Individuals Interactive NS September 21–70 yr, Medical Low-tailored High-tailored 0
18
2008 interested consumer 2004 had smoked at least contraindications
in their own website 100 cigarettes in his for NRT,
health care or her lifetime, Not currently
Currently smoked at enrolled in the
least 10 cigarettes/ HMO,
day, and had Lack of adequate
smoked in the past 7 Internet/e-mail
days, access,
was seriously Already enrolled in
G-130
Year data
considering quitting another smoking-
in the next 30 days, cessation
was a member of program,
either Group Health Medical
or HFHS, contraindications
had home or work for NRT,
access to the Currently using
Internet and an e- pharmacotherapy
mail account that he to quit smoking
or she used at least
twice weekly,
was not currently
enrolled in another
formal smoking-
cessation program
or was not currently
using
pharmacotherapy for
smoking cessation,
had no medical
contraindications for
NRT
Swartz, Individuals Interactive Home/ NS >18 yr, <18 yr 90 day wait Access to 1
200619 interested consumer residence Daily smoker, period for website
in their own website Wish to quit in the access to
health care Remote: next 30 days, website
work site Ability to access
website
NS = not specified, yr = year, NRT = nicotine replacement therapy, CHESS = Comprehensive Health Enhancement Support System
G-131
Reference List
1 An LC, Klatt C, Perry CL et al. The RealU online cessation intervention for college smokers: a randomized controlled trial. Prev Med 2008; 47(2):194-9.
2 Brendryen H, Drozd F, Kraft P. A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending):
randomized controlled trial. J Med Internet Res 2008; 10(5):e51.
3 Curry SJ, McBride C, Grothaus LC, Louie D, Wagner EH. A randomized trial of self-help materials, personalized feedback, and telephone counseling with
nonvolunteer smokers. 1995; 63(6):1005-14.
4 Dijkstra A. Working mechanisms of computer-tailored health education: Evidence from smoking cessation. 2005; 20(5):527-39.
5 Haug S, Meyer C, Schorr G, Bauer S, John U. Continuous individual support of smoking cessation using text messaging: A pilot experimental study.
Nicotine Tob Res 2009.
6 Japuntich SJ, Zehner ME, Smith SS et al. Smoking cessation via the internet: a randomized clinical trial of an internet intervention as adjuvant treatment in a
smoking cessation intervention. Nicotine Tob Res 2006; 8 Suppl 1:S59-67.
7 Patten CA, Croghan IT, Meis TM et al. Randomized clinical trial of an Internet-based versus brief office intervention for adolescent smoking cessation.
Patient Educ Couns 2006; 64(1-3):249-58.
8 Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. Standardized, Individualized, Interactive, and Personalized Self-Help Programs for Smoking
Cessation. 1993; 12(5):399-405.
9 Prokhorov AV, Kelder SH, Shegog R et al. Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking
prevention and cessation curriculum for culturally diverse high-school students. Nicotine Tob Res 2008; 10(9):1477-85.
10 Shiffman S, Paty JA, Rohay JM, Di Marino ME, Gitchell J. The efficacy of computer-tailored smoking cessation material as a supplement to nicotine
polacrilex gum therapy. Arch Intern Med 2000; 160(11):1675-81.
11 Schumann A, John U, Rumpf H-J, Hapke U, Meyer C. Changes in the "stages of change" as outcome measures of a smoking cessation intervention: A
randomized controlled trial. 2006; 43(2):101-6.
12 Schumann A, John U, Baumeister SE, Ulbricht S, Rumpf HJ, Meyer C. Computer-tailored smoking cessation intervention in a general population setting in
Germany: outcome of a randomized controlled trial. Nicotine Tob Res 2008; 10(2):371-9.
13 Severson HH, Gordon JS, Danaher BG, Akers L. ChewFree.com: evaluation of a Web-based cessation program for smokeless tobacco users. Nicotine Tob
Res 2008; 10(2):381-91.
14 Strecher VJ, Kreuter M, Den Boer D-J, Kobrin S, Hospers HJ, Skinner CS. The effects of computer-tailored smoking cessation messages in family practice
G-132
settings. 1994; 39(3):262-70.
15 Strecher VJ, Marcus A, Bishop K et al. A randomized controlled trial of multiple tailored messages for smoking cessation among callers to the cancer
information service. J Health Commun 2005; 10 Suppl 1:105-18.
16 Strecher VJ, Shiffman S, West R. Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine
patch therapy. Addiction 2005; 100(5):682-8.
17 Strecher VJ, Shiffman S, West R. Moderators and mediators of a web-based computer-tailored smoking cessation program among nicotine patch users.
Nicotine Tob Res 2006; 8 Suppl 1:S95-101.
18 Strecher VJ, McClure JB, Alexander GL et al. Web-based smoking-cessation programs: results of a randomized trial. Am J Prev Med 2008; 34(5):373-81.
19 Swartz LH, Noell JW, Schroeder SW, Ary DV. A randomised control study of a fully automated internet based smoking cessation programme. Tob Control
2006; 15(1):7-12.
G-133
Evidence Table 15. Description of consumer characteristics in addressing impact of CHI applications on intermediate outcomes in smoking
Control
year Interventions Age Race, n(%) Income Education, n(%) SES n(%) Status characteristics
Smoking
An, 20081 Control group Mean, 19.8 Black non- NS Yr in school: NR F,196 (75.4) Employment:
SD, 1.6 Hispanic, 24(9.2) Freshman, 80 Not working, 84
(30.8) (32.3)
Sophomore, 64 Part-time, 159 (61.2)
(24.6) Full-time, 17 (6.5)
Junior, 67 (25.8) Internet use:
Senior, 49(18.9) 1–5 days/week,
26 (10.0)
6–7 days/week,
233 (90.0)
RealU Mean, 20.1 Black non- NS Yr in school: NR F,181 (70.4) Employment:
intervention SD, 1.6 Hispanic, Freshman,67 (26.1) Not working, 81
group 20(7.8) Sophomore, 63 (31.6)
(24.5) Part-time, 161 (62.9)
Junior, 68 (26.5) Full-time, 14 (5.5)
Senior, 59 (23.0) Internet use:
1–5 days/week,
32 (12.5)
6–7 days/week,
225 (87.6)
Brendryen, Self-help Mean, 39.5 Has college F, 72(50) Cigarettes smoked
2
2008 booklet degree, 70(49) per day
SD, 11.0
Mean 16.6
SD 7.2
Self-efficacy
Mean 5.1
SD 1.4
Happy Ending Mean, 39.7 Has college F, 73(50) Cigarettes smoked
program (HE) degree, 76(52) per day
SD, 10.8
G-134
Evidence Table 15. Description of consumer characteristics in addressing impact of CHI applications on intermediate outcomes in smoking (continued)
Control
Mean 17.6
SD 7.0
Self-efficacy
Mean 5.1
SD 1.3
Curry, 1995 Control Mean, 41.2 White, 285(87) > Finished high F, 157(48) No. cigarettes / day
3
$25,000 school, 302(92) Mean, 17.1, SD 10.3
SD, 11.9 ,
230(70) Stage of readiness to
quit smoking
Precontemplation,
121(37)
Contemplation,
134(41)
Preparation, 72(22)
Booklet Mean, 41.3 White, 294(89) > Finished high F, 175(53) No. cigarettes / day
$25,000 school, 300(91) Mean, 17.2, SD 10.5
SD, 11.5 ,
quit smoking
Precontemplation,
125(38)
Contemplation,
132(40)
Preparation, 69(21)
G-135
Control
Feedback Mean, 40.9 White, 283(86) > Finished high F, 174(53) No. cigarettes / day
$25,000 school, 303(92) Mean, 17.7, SD 11.1
SD, 11.1 ,
quit smoking
Precontemplation,
132(40)
Contemplation,
135(41)
Preparation, 63(19)
Phone Mean, 40.8 White, 129(86) > Finished high F, 88(59) No. cigarettes / day
$25,000 school, 134(89) Mean, 17.1, SD 10.1
SD, 11.9 ,
quit smoking
Precontemplation,
65(43)
Contemplation,
65(43)
Preparation, 22(15)
Dijkstra, Standard NR NR NR NR NR NR NR
2005 4 information
Personalization
Adaptation
Feedback
Hang, 2009 No Intervention Mean, 25.4 NR NR > 10 years, 63(98) NR F, 40(63) Living in a stable
5
partnership, 37(58)
SD, 4.9
Self-efficacy (1-5)
G-136
Control
Mean 2.7
SD 0.7
1 SMS per Mean, 25.2 > 10 years, 46(92) F, 28(56) Living in a stable
week partnership, 26(52)
SD, 4.8
Self-efficacy (1-5)
Mean 2.7
SD 0.6
3 SMS per Mean, 24.3 > 10 years, 54(90) F, 31(52) Living in a stable
week partnership, 25(42)
SD, 3.8
Self-efficacy (1-5)
Mean 2.8
SD 0.7
Japuntich, Bupropion plus Mean, 41 White non- NS <high school4 (2.8), NR F, (54.9) Cigarettes per day:
20066 Counseling SD, 11.8 Hispanic, (82.6) High school/GED, mean, 22.1
alone 40 (27.8) SD, 10.2
Some college/tech FTND Test for
school, 68 (47.2) Nicotine
College/graduate Dependence:
school, 31(21.5) mean, 5.5
SD, 4.4
CES-D for
Depression:
mean, 5.5
SD, 4.4
With CHESS Mean, 40.6 White non- NS <High school, NR F, (55.0) Cigarettes per day:
SCRP SD, 12.4 Hispanic, (75.4) 5 (3.6) mean, 21.1
High school/GED, SD, 9.5
41 (29.5) FTND Test for
Some college/tech nicotine dependence:
school, 72 (51.8) mean, 5.4
College/graduate SD, 2.1
G-137
Control
school, 21 (15.1) CES-D for
depression:
mean, 5.2,
SD, 4.7
Pattens, BOI Mean, 15.8 White non- NS 6th-8th grade, (9) NR F, (49) Literacy--"easy to
7 th th
2006 SD, 1.4 Hispanic, (86) 9 -11 grade, (79) read English":
th
>12 grade, (13) (81)
Use of internet:
little to no use (12)
some use (41)
a lot of use (48)
Computer :
at home (77)
internet access (79)
th th
SOS Mean, 15.7 White non- NS 6 -8 grade, (16) NR F, (50) Literacy--easy to
th th
SD, 1.3 Hispanic, (90) 9 -11 grade, (71) read English:
th
>12 grade, (13) (86)
Use of internet:
little to no use (14)
some use (33)
a lot of use (53)
Computer:
in home (70)
internet access (78)
Prochaska, Characteristics NR NR NR NR NR NR
8
1993 not reported by
subgroup
Prokhorov, Clearing the Air NR NR NR NR NR NR Among nonsmokers,
9
2008 self-help NonHispanic
booklet 291(58.1)
ASPIRE CD- Among nonsmokers,
ROM NonHispanic
244(42.6)
Schiffman, User Guide Mean, 41.7 NS Gross Mean, 13.5 yr NR F, (54.9) Previous cessation
200010 only SD, 13 House SD, 2.1 and nicotine
Hold replacement therapy
Income. experience :
USD Previous quit
mean, attempt, ( 91.6)
38,000 Prior nicotine patch
G-138
Control
SD, use, (38.7)
22,300 Prior nicotine gum
use, (20.0)
Smoking history
(mean/SD):
Cigarettes per day:
26.9/12.2
Yr of smoking:
23.1/12.6
Time of first cigarette
(minutes): 14.6/31.7
No. of lifetime
cessation attempts:
4.5/7.3
Initial motivation and
confidence
(mean/SD) (range, 1-
5):
Level of motivation:
4.3/0.7
Confidence of
success: 3.9/1.0
CQP Mean, 41 NS Gross Mean, 13.6 NR F, (53.4) Previous cessation
SD, 12.7 House SD, 2.2 and nicotine
Hold replacement therapy
Income, experience :
USD Previous quit
mean, attempt, ( 91.8)
39800 Prior nicotine patch
SD, use, (34.9)
22300 Prior nicotine gum
use,( 20.0)
Smoking history
(mean/SD):
Cigarettes per day:
26.1/12.1
Yr of smoking:
22.3/12.4
(minutes): 16.8/27.1
No. of lifetime
G-139
Control
cessation attempts:
5.5/17.7
confidence
5):
4.3/0.8
Confidence of
success: 4.0/1.0
Committed Mean, 41.7 NS Gross Mean, 13.6 NR F, (54.3) replacement therapy
Quitter SD, 12.9 House SD, 2.1 experience:
Program + Call Hold Previous quit
Income, attempt, (90.9)
USD Prior nicotine patch
mean, use, (35.1)
39,100 Prior nicotine gum
SD, use, (20.2)
22,200 Smoking history
(mean/SD):
Cigarettes per day:
26.0/12.1
Yr of smoking:
22.7/12.5
(minutes): 14.1/22.8
No. of lifetime
cessation attempts:
5.8/18.7
confidence
5):
4.3/0.8
Confidence of
success: 4.0/1.0
Schumann, Characteristics
11
subgroup
G-140
Control
Schumann, Assessment- Mean, 44.2 NS NS <10 yr, 81 (26.2) NR Self-reported health
200812 only control SD, 13.2 10 yr, 154 (49.8) status, score 0–100:
group >10 yr, 62 (20.1) mean, 74.2
SD, 17.2
Daily cigarette
smoking:
245 (79.3)
Cigarettes per day:
mean, 15.4
SD, 8.9
Intention to quit
within the next 6
months:
79 (32.2)
Computer- Mean, 44.8 NS NS <10 yr, 77 (25.5) NR Self-reported health
tailored TTM- SD, 14.6 10 yr, 156 (51.7) status, score 0–100:
based >10 yr, 54 (17.9) mean, 75.7
intervention SD, 15.4
group Daily cigarette
smoking:
240 (79.5)
Cigarettes per day:
mean, 15
SD, 7.2
Intention to quit
within the next 6
months:
48 (20.0)
Severson, Text-based Mean, 36.9 White non- NS <High school, NR Self-efficacy:
13
2008 website (Basic SD, 9.6 Hispanic, 38(3.0) mean, 2.4 SD, 1
Condition) 1234(97.7) High school, Readiness to quit:
Black non- 199(15.8) mean, 8.1 SD, 1.8
Hispanic, College, 548(43.4) Currently smoking:
15(1.2) >College 478(37.8) 67 (5.3)
Latino/Hispanic, Rural: 459 (36.6)
14(1.1)
API, 4(0.3)
AIAN, 17(1.3)
Strecher, Characteristics
not reported by
G-141
Control
1994 14 subgroup
Study 1
Strecher, Characteristics
15
subgroup
Strecher, Control Baseline characteristics not reported
200516 Tailored
intervention
Strecher, Non-tailored Baseline characteristics not reported
200617 web-based
cessation
material
Strecher, Low-tailored Baseline characteristics not reported
18
2008 High tailored
Tailored Web- Mean, 36.7 White non- NS <High school, NR Self-efficacy:
based SD, 9.7 Hispanic, 28(2.2) mean, 2.4
intervention 1228(97.5) High school, SD, 1
(Enhanced Black non- 208(16.5) Readiness to quit:
Condition) Hispanic, 12(1) College, 542(43.0) mean, 8.2
Latino/Hispanic, >College, 482(38.3) SD, 1.9
17(1.3) Currently smoking:
API, 5(0.4) 43 (3.4)
AIAN, 24(1.9) Rural: 447 (35.7)
CQPLAN
Swartz, 90 day wait Range, White non- NS NS NR M, 88 (48.9) Cig/day:
19
2006 period for 18 to >70 Hispanic, F, 92 (50.6) <16:
access to 152(84.4) 69 (38.6)
website Black non- 16-20:
Hispanic, 9(5) 56 (28.1)
Latino/Hispanic, 21-30:
7(3.9) 43 (24)
AIAN, 5(2.8) 31+:
Other, (1.7 ) 17 (9.4)
G-142
Control
Video-based Range, White non- NS NS NR M, 80 (46.8) Cig/day:
internet site 18 to >70 Hispanic, F, 91 (53.2) <16:
136(79.5) 55 (31.9)
Black non- 16-20:
Hispanic, 63(36.8)
14(8.2) 21-30:
Latino/Hispanic, 34 (20.2)
8(4.7) 30+:
AIAN, 2(1.2) 19 (11)
Other, 9 (5.3 )
NR= Not Reported, NS= Not Significant, SD= Standard Deviation, SES= Socioeconomic Status, Yr= year, API = Asian Pacific Islander, AIAN = American Indian/Alaska Native,
M= male, F = female, CQP = Committed Quitters Program, USD = United States Dollar
Reference List
Cessation. 1993; 12(5):399-405.
G-143
Res 2008; 10(2):381-91.
settings. 1994; 39(3):262-70.
2006; 15(1):7-12.
G-144
Evidence table 16. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in alcohol abuse (KQ1b)
Measure
Control at BL Measure Ratios at
Author, Measure at Measure at at Time Measure at Final Time
year Outcomes Intervention n Time point 2 Time point 3 point 4 Time point points Significance
Smoking
An, 20081 %abstinent for Control 260 8 wks (%): 16.2 20 wks (%) 30 weeks (%) p<0.001
30 days 19.6 23.1
RealU 257 8 wks (%): 16 20 wks (%) 30 weeks (%)
intervention 95 % CI: 24.1 40.5
0.64-1.66 95% CI: 95% CI:1.58-3.40
0.88-2.04
Brendryen, Repeated Self-help 146 10(7) OR 3.43, P
2008 2 Points of booklet .002
Abstinence (1 +
3 + 6 + 12
months)
Happy Ending 144 29(20)

program (HE)
Curry, 7-day Control 324 Precontemplation .07. .95, .86

1995 3 abstinence at (119 group (13), for
21 months , contemplation
133, group (11), for
72) preparation group
(18)
Booklet 327 Precontemplation

(125 group (10), for
, contemplation
(15)
Feedback 323 Precontemplation

(128 group (5), for
, contemplation
preparation group
G‐145

Evidence table 16. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in alcohol abuse (KQ1b) (continued)
Measure
63) (16)
Phone 150 Precontemplation

(64, group (16), for
64, contemplation
22) group (11), for
preparation group
(23)
Abstinent at 3, Control 324 Precontemplation .03, .80, .56

12 and 21 (119 group (1), for
months , contemplation
133, group (1), for
(6)
Booklet 327 Precontemplation

(125 group (0), for
, contemplation
131, group (0.5), for
(3)
Feedback 323 Precontemplation

(128 group (1), for
, contemplation
132, group (2), for
(3)
Phone 150 Precontemplation

(64, group (5), for
64, contemplation
group (2), for
G‐146

Measure
(9)
Dijkstra, Affective Standard 51 NR At time of P 0.048

4
2005 attitude intervention
Mean, 5.61
Personalization 50 NR At time of
intervention
Mean, 5.13
Adaptation 51 NR At time of
intervention
Mean, 5.48
Feedback 50 NR At time of
intervention
Mean, 5.55
Cognitive Standard 51 NR At time of P 0.028

attitude intervention
Mean, 2.62
Personalization 50 NR At time of
intervention
Mean, 2.52
Adaptation 51 NR At time of
G‐147

Measure
intervention
Mean, 2.53
Feedback 50 NR At time of
intervention
Mean, 2.79
Quitting Standard NR NR 4 months, (22.9) P 0.042

attempts
Personalization NR NR 4 months, (44.7)
Adaptation NR NR 4 months, (28.6)
Feedback NR NR 4 months, (48.5)
Hang, 2009 Number of No intervention 64 Mean 11.7 3 months, Mean

5
cigarettes 9.5, SD 5.5
smoked per day SD 7.5
SMS 1 per 50 Mean 12.4 3 months, Mean

week 10.2, SD 6.5
SD 7.3
SMS 3 per 60 Mean 11.2 3 months, Mean P .91

week 9.7, SD 6.4
SD 6.3
24 hour quit No intervention 64 3 months, N 26, P .47

attempt
(41)
SMS 1 per 50 3 months, N 20,
G‐148

Measure
week (42)
SMS 3 per 60 3 months, N 30,

week
(50)
Japuntich, Abstinent Control 144 3 months (%): 6mos (%):15 NR

20066 (20.8)
CHESS SCRP 140 3 months (%): 6mos (%):11.8

(22.9) OR:1.48 (.66-2.62)
OR:1.13 (.64-
1.98)
Pattens, Smoking Control 69 8 wks 12 wks 24 wks (%): 12 0.217
20067 abstinence 95% CI:5-22
Internet based 70 8 wks 12 wks 24 wks (%): 6 0.217
intervention 95% CI:2-14
Prochaska, Point ALA+ (self-help 0
1993 8 Prevalence manual)
Abstinence,
Precontemplatio TTT 0
n stage (individualized
manual)
ITT (interactive 0
computer
report)
PITT 0
(personalized
counselor
+TTT+ITT)
Point ALA+ 0 (11.1)
G‐149

Measure
Prevalence TTT 0 (5.0)
Abstinence,
Contemplation ITT 0 (17.6)
stage
PITT 0 (5.3)
Point ALA+ 0 (10.8)

Prevalence
Abstinence, TTT 0 (15.4)
Preparation
stage ITT 0 (25.0)
PITT 0 (15.6)
Point ALA+ 0 (11.6)

Prevalence
Abstinence, TTT 0 (29.4)
Preparation
stage ITT 0 28.0)
PITT 0 (27.9)
Prokhorov, Smoking Control 516 (5.8) OR 2.9

9
2008 initiation rates at (Clearing the
18 months Air self-help Confidence
(nonsmokers at booklet) interval 95%
BL) (1.1 7.8)
ASPIRE CD- 582 (1.9)

ROM
Smoking Control 34 (61.8) OR 1.0

cessation rates (Clearing the
at 18 months Air self-help Confidence
interval 95%
G‐150

Measure
(smokers at BL) booklet) (0.3 2.7)
Schiffman, Abstinence Control 1203 28-day 10-wks abstinence p<0.001

200010 rates abstinence at 6 at 12 weeks:18.9
weeks (%): 95% CI:2.044
28.6 (1.489-2.807)
95% CI:1.780
(1.342-2.360)
Computer 1217 28- day 10-wks abstinence
tailored abstinence at 6 at 12 wks:32.3
smoking wks:41.6, 95% CI:2.044
cessation 95% CI:1.780 (1.489-2.807)
materials (CQP) (1.342-2.360)
Schumann, Average Control (no 245 0.038
2006 11 probability of intervention)
progression
(precontemplati Tailored letters 240 0.032
on and
contemplation)
Average Control (no 245 0.084

probability of intervention)
regression
(precontemplati Tailored letters 240 0.034
on and
contemplation)
Schumann, Point- Control 309 6 mos: 46 12 mos: 55 18 mos:55 24 mos: 69 NS

200812 prevalence Computer- 302 6 mos:46 12 mos :56 18 mos:55 24 mos:63
abstinence tailored
smoking
cessation
intervention
Prolonged Control 309 12 mos:38 18 ms:46 24 mos:46
abstinence Computer- 302 12 mos:35 18 mos:45 24 mos:46
tailored
G‐151

Measure
smoking
cessation
intervention
Severson, Tobacco Control 100 3 mos:26.9 6 mos:31 3 and 6 mos:21.2 Time point 2,
200813 abstinence 0.001
(complete case) Interactive, 159 3 mos:44.2 6 mos:46.2 3 and 6 mos:40.6 Time point 3,
tailored 0.001
web-based Final Time
intervention point, 0.001
Tobacco Control 100 3 mos:13.9 6 mos:14.7 3 and 6 mos:7.9 Time point 2,
abstinence 0.001
(intent-to-treat) Interactive, 159 3 mos:19.5 6 mos:19.3 3 and 6 mos:12.6 Time point 3,
tailored web- 0.001
based Final time
intervention point, 0.001
Smokeless Control 128 3 mos:32.4 6 mos:35.3 3 and 6 mos:27.2 Time point 2,
tobacco use Interactive, 189 3 mos:49.6 6 mos:51.3 3 and 6 mos:48.2 0.001
abstinence tailored web- Time point 3,
(complete case) based 0.001
intervention Final time
point, 0.001
Smokeless Control 128 3 mos:16.8 6 mos:16.8 3 and 6 mos:10.1 Time point 2,
tobacco use Interactive, 189 3 mos:21.9 6 mos:21.4 3 and 6 mos:15.0 0.001
abstinence tailored web- Time point 3,
(intent-to-treat) based 0.01
intervention Final time
point, 0.001
Strecher, 7-day Control (generic (7.4) P <.10
1994 14 abstinence letter)
Study 1 Tailored letter (20.8)
7-day Control (generic (7.1)

abstinence letter) / light
smoker
G‐152

Measure
Control (generic (7.7)
letter) / heavy
smoker
Tailored letter / (30. 7)

light smoker
Tailored letter / (7.1)

heavy smoker
Strecher, 7-day Control (no (7.3) P < .05

1994 14 abstinence letter) / light
smoker
Study 1
Control (no (9.8)
letter) / heavy
smoker

light smoker

heavy smoker
Strecher, 7-day SU (single (8.1) Difference

15
2005 abstinence at untailored between
12 months booklet) groups 3+4
(intent to treat and groups
2
analysis) 1+2 (Wald Χ
4.7, p <.05;
OR 1.41, 1.04
– 1.99)
G‐153

Measure
ST (single (7.2)
tailored booklet)
MT (multiple (10.3)
tailored
materials)
MRT (multiple (10.5)

retailored
materials)
7-day SU (single (41.9) Difference

abstinence at untailored between
12 months of booklet) groups 3+4
subjects who and groups
2
were abstinent 1+2 (Wald Χ
at 5 months 1.4, p .2; OR
(intent to treat 1.44, 0.78 –
analysis) 2.68)
ST (single (37.4)
tailored booklet)
MT (multiple (41.7)
tailored
materials)

retailored
materials)
7-day SU (single (57.1) Difference

abstinence at untailored between
12 months of groups 3+4
G‐154

Measure
subjects who booklet) and groups
2
were abstinent 1+2 (Wald Χ
at 5 months (per 4.1, p < .05;
protocol OR 2.16, 1.03
analysis) – 4.65)
ST (single (51.4)
tailored booklet)
MT (multiple (63.3)
tailored
materials)

retailored
materials)
Strecher, 28 day Control 588 6 wks (%): 46.8 12 wks .008

200516 abstinence rate CQ plan 640 6 wks (%): 54.4 12 wks
OR:1.36
95% CI:
1.08-1.70
10 week Control 418 6 wks 12 wks (%): 43.3 .0004
continuous CQ Plan 446 6 wks 12 wks (%): 55.4
rates OR: 1.63
95% CI:1.24-2.13
Strecher , Tobacco related CQ-PLAN 1491 6 wks 12 wks:55.6 p<0.001
200617 illness 95% CI:
CONTROL 1491 6 wks 12 weeks:38.2
Non-smoking CQ PLAN 1491 6 wks 12 wks:57.7 p<0.001

children in
household CONTROL 1491 6 wks 12 wks:38.5
Frequency of CQ-PLAN 1491 6 wks 12 wks:55.4 p<0.001

alcohol CONTROL 1491 6 wks 12 wks:36.5
G‐155

Measure
consumption
Strecher, Depth of High depth 466 6 mos follow 0.213
18 efficacy efficacy up:32.4
2008
expectation of expectation
smoking Low depth 478 6 mos follow
cessation efficacy up:28.5
intervention expectation
Depth of High depth 494 6 mos follow Final time
outcome outcome up:32.2 point, 0.242
expectation of expectation
smoking Low depth 450 6 mos follow
cessation outcome up:28.7
intervention expectation
Depth of High depth 488 6 mos follow Final time
success stories success story up:34.3 point, 0.018
of smoking Low depth 456 6 mos follow
cessation success story up:26.8
intervention
Personalization High 481 6 mos follow Final time
of message personalization up:33.6 point, 0.039
source of message
source
Low 463 6 mos follow
personalization up:27.4
of message
source
Timing of Multiple 487 6 mos follow Final time
message message up:29.6 point 0.567
exposure exposure
Ingle message 457 6 mos follow
exposure up:31.3
Swartz, Automated Control 9 90 day (%):8.2 0.002
200619 behavioral Those who 21 90 day:24.1
intervention for received OR:3.57
cessation of immediate 95% CI:1.54-8.27
smoking at 90 access to the
day follow-up web site for
automated
G‐156

Measure
behavioral
intervention for
smoking
Control (intent 9 90 day:5 0.015
to treat model)
behavioral 21 90 day:12.3,
intervention for OR:2.66
smoking (intent 95% CI:1.18-5.99
to treat model)
CI = confidence interval, NR = not reported, NS = not specified, OR = odd ratio, wks = weeks, mos = months
Reference List
G‐157

Cessation. 1993; 12(5):399-405.
Res 2008; 10(2):381-91.
settings. 1994; 39(3):262-70.
2006; 15(1):7-12.
G‐158

Evidence Table 17. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in obesity (KQ1b)
Year data
Obesity
Booth, Individuals Personal NS NS BMI was between <18 yr, ED group
20081 interested in monitoring 24.5 and 37 kg/ m2, Pregnant or
their own device Internet access lactating or were EX group
health care currently
receiving
medications for
Type 1 or Type
2 diabetes
Burnett, Overweight An Home / Res Ns Consenting 30 – 50 yr Ns Paper and Computer
1985 2 females interactive old females to the pencil Assisted
Obesity lap sized newspaper method of method of
computer advertisement providing providing
feedback feedback
Cussler, Individuals Interactive NS NS 40 - 55 yr, Self Internet 2
20083 interested in consumer Women, directed group
their own website have a BMI between group
health care 25.0 and 38.0 kg/m2,
Nonsmoker and be
free from major
illnesses,
Internet access
Frenn, 2005 Students of Computer Computer labs NR 7th grade student ns Regular 8 sessions
4
7th grade based in school who could read in Classroom Internet
Obesity interactive English / Spanish and assignment based
web completed the s interactive
consent form model based
on HP/TM
Hunter, Individuals Interactive NS 2006 18 - 65 yr, Lost more than Usual care Behavioral 2.5
5
2008 interested in consumer Weight within 5 10 pounds in the Internet
their own website pounds or above their previous 3 treatment
health care maximum allowable months,
weight for the USAF, Used
Personal computer prescription or
with Internet access, over-the-counter
plans to remain in the weight-loss
local area for 1 year medications in
the previous 6
months,
had any physical
G-159
Evidence Table 17. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in obesity (KQ1b) (continued)
Year data
activity
restrictions,
had a history of
myocardial
infarction,
stroke,
or cancer in the
last 5 years,
reported
diabetes,
angina,
or thyroid
difficulties; or
had orthopedic
or joint
problems,
Women were
excluded if they
were currently
pregnant or
breast-feeding,
or had plans to
become
pregnant in the
next year
Kroeze, Individuals Interactive Worksites and 2003-2004 18-65 yr, Generic Interactive- 3
6
2008 interested in consumer 2 Sufficient condition tailored
their own website neighborhoods understanding of the condition
health care in the urban Dutch language,
area of No diet prescribed by Print-tailored
Rotterdam a dietitian or condition
physician, and no
treatment for
hypercholesterolemia
McConnon, Individuals Interactive Home/ 2003/ NS 18 - 65 yr, Usual care Internet 1
20077 interested in consumer residence BMI 30 or more, group
their own website able to access
health care internet at least 1
time a week,
able to read and write
G-160
Year data
English
Taylor, Overweight Pocket Home / Res NS Overweight women Bulemia, Computer 1200 calorie
9
1991 women Computer BMi b/w 25 and 35 Depression, Assisted diet followed
Device kg/m^3 alcohol and drug Therapy by CAT
dependence, (CAT)
psychosis, DSM
III R
Williamson, Individuals Interactive Clinician office NS 11 - 15 yr, Control and Control and 2
200610 interested in consumer African-American, intervention intervention
their own website Female, adolescents parents
health care BMI above the 85th
percentile for age and
gender based on
1999 National Health
and Nutrition
Examination Study
normative data,
at least one obese
biological parent,
as defined by
BMI > 30,
one designated
parent who was
overweight (BMI >
27),
adolescent’s family
was willing to pay
$300 out-of pocket
expenses toward the
purchase of the
computer worth
>$1000,
the family home had
electricity and at least
one functional
telephone line
Womble , Individuals Interactive NS 2001/ 18-65 yr, Type 1 or 2 0.5
11
2004 interested in consumer NS BMI: 27-40 kg/m2, diabetes,
their own website Daily access to the Uncontrolled
G-161
Year data
health care internet HTN
(BP>140/90),
History of
cerebrovascular,
cardiovascular,
kidney or liver
disease,
Use of
medications
known to affect
body weight,
pregnancy or
lactation
weight
loss>=5% of
initial weight,
Use of anorectic
agents in the
previous 6
months,
bulimia,
major
depression,
or other
psychiatric
illness
significantly
disrupted daily
functioning
NS = not specified, yr = year, BMI = body mass index, kg/m2 = Kilograms per square meter, BP = blood pressure, HTN = hypertension
Reference List
1 Booth AO, Nowson CA, Matters H. Evaluation of an interactive, Internet-based weight loss program: a pilot study. Health Educ Res 2008; 23(3):371-81.
2 Burnett KF, Taylor CB, Agras WS. Ambulatory computer-assisted therapy for obesity: A new frontier for behavior therapy. 1985; 53(5):698-703.
3 Cussler EC, Teixeira PJ, Going SB et al. Maintenance of weight loss in overweight middle-aged women through the Internet. Obesity (Silver Spring) 2008;
16(5):1052-60.
G-162
4 Frenn M, Malin S, Brown RL et al. Changing the tide: An Internet/video exercise and low-fat diet intervention with middle-school students. 2005; 18(1):13-
21.
5 Hunter CM, Peterson AL, Alvarez LM et al. Weight management using the internet a randomized controlled trial. Am J Prev Med 2008; 34(2):119-26.
6 Kroeze W, Oenema A, Campbell M, Brug J. The efficacy of Web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a
randomized, controlled trial. J Nutr Educ Behav 2008; 40(4):226-36.
7 McConnon A, Kirk SF, Cockroft JE et al. The Internet for weight control in an obese sample: results of a randomised controlled trial. BMC Health Serv Res
2007; 7:206.
8 Morgan PJ, Lubans DR, Collins CE, Warren JM, Callister R. The SHED-IT Randomized Controlled Trial: Evaluation of an Internet-based Weight-loss
Program for Men. Obesity (Silver Spring) 2009.
9 Taylor CB, Agras WS, Losch M, Plante TG, Burnett K. Improving the effectiveness of computer-assisted weight loss. 1991; 22(2):229-36.
10 Williamson DA, Walden HM, White MA et al. Two-year internet-based randomized controlled trial for weight loss in African-American girls. Obesity
(Silver Spring) 2006; 14(7):1231-43.
11 Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of a commercial internet weight
loss program. Obes Res 2004; 12(6):1011-8.
G-163
Evidence Table 18. Description of consumer characteristics in studies addressing the impact of CHI applications on intermediate outcomes in obesity (KQ1b)
Control
Author, Gender, Marital
year Interventions Age Race, n(%) Income Education, n(%) SES n(%) Status Other outcomes
Obesity
Booth, Comparison NS NS NS NS NR NS NS BMI:
20081 mean, 29
SD, 2.3
Weight (kg):
mean, 80.5
SD, 8.6
Online Diet Mean, 46.4 NS NS NS NR NS NS BMI:
advice and SD, 12.5 mean, 29.9
exercise SD, 2.7
program Weight (kg):
mean, 84.3
SD, 11.3
Online Mean, 46.2 NS NS NS NR NS NS BMI:
exercise SD, 9.2 mean, 30.1
program only SD, 3.4
Weight (kg)
mean, 82
SD, 10.8
Burnett, Paper and 39.8 SD 5.5 Ns Ns Ns Ns All F
2
1985 Pencil
Obesity method of
providing
feedback
A lap sized 43.2 SD 8.8 All F
computer
Cussler, Self directed Mean, 48.2 NS NS NS NR NR NR Weight (kg):
3
2008 group SD, 4.2 mean, 82
SD, 10.8
BMI:
mean, 30.1
SD, 3.4
Internet group Mean, 48.3 Weight(kg):
SD, 4.4 mean, 84.4
SD, 12.6
BMI:
mean, 30.6
SD, 3.9
Frenn, Regular 12—14yrs Diet : Diet: Seventh grade Students NR Diet: M 22
2005 4 Classroom Asians 2 Free (44.9) F 27
G-164
(continued)
Control
Obesity Assignments (4.1); lunch (55.1);
Blacks 35(71.4) Activity: M
15 ; 30 (50) F 30
(30.6); Reduce (50)
Hispanic d
s 17 6(12.2);
(34.7); No
Native reductio
American n
s 4 (8.2); 8(16.0)
Whites 4
(8.2); Activity:
Others 7 Free
(14.3) lunch
42(70.0)
Activity: ;
Asians 3 Reduce
(5); d
Blacks 8(13.3);
16 No
(26.7); reductio
Hispanic n
s 24 (40); 10(16.7)
Native
American
s 4 (6.5);
Whites 4
(8.9);
Others 9
(15)
8 sessions Diet: Diet: Diet group:
Internet Asians 0 Free M 12(30); F
based (0); lunch 28(70)
interactive Blacks 8 30(75.0) Activity: M
model based (20); ; 14 (26.3) F
on HP/TM Hispanic Reduce 29 (73.7)
s 22 (55); d
Native 5(12.5);
American No
s 1 (2.5); reductio
Whites 5 n
G-165
(continued)
Control
(12.5); 5(12.5)
Others 4
(10) Activity:
Free
Activity: lunch 31
Asians 0 (72.1);
(0); Reduce
Blacks 9 d 6(14);
(20.9); No
Hispanic reductio
s 23 n 6 (14)
(53.3);
Native
American
s 0 (0);
Whites 4
(9.3);
Others 7
(16.3)
Hunter, Usual care Mean, 34.4 C, 222 NS 12-16 years, 222(61.7) NR F, 222(50.5) NR
5
2008 SD, 7.2 C, 53.2
Behavioral Mean, 33.5 C, 224 NS 12-16 years, 224(63.9) NR F, 224(50.0)
Internet SD, 7.4 C, 58.0
treatment
Kroeze, Generic Mean, 44.1 NS NS Elementary,3(2) NR F,150(56.0) NR BMI (kg/m2):
6
2008 condition SD, 9.7 Lower secondary, 28(18.4) mean, 25.3
Higher secondary, 56(37.4) SD, 3.8
Tertiary, 63(42.2)
Interactive- Mean, 44 Elementary,4(2.6) F,151(53.6) BMI (kg/m2):
tailored SD, 10.56 Lower secondary,29(19.2) mean, 25.5
condition Higher secondary,51( 33.8) SD, 3.8
Tertiary, 67(44.4)
Print-tailored Mean, 43.4 Elementary,15(3.6) F,141(55.3) BMI (kg/m2):
condition SD, 10.1 Lower secondary,26(18.6) mean, 25.5
Higher secondary,49(35.0) SD, 4.3
Tertiary,61(42.9)
McConnon, Usual care Mean, 47.4 NS NS NS NR NR NR Weight (kg):
7
2007 mean, 94.9
BMI:
mean, 34.4
G-166
(continued)
Control
Quality of Life
(Euro QoL):
mean, 61.5
Physical Activity
(Baecke):
mean, 6.7
Internet group Mean, 48.1 Weight (kg):
mean, 97.5
BMI:
mean, 34.35
Quality of Life
(EuroQoL):
mean, 70
Physical Activity
(Baecke):
mean, 6.8
Morgan, One 34 SD 11.6 NS NS Student: 14 Meas All M
8
2009 information Non Acad Staff: 13 ured
Obesity session + Acad Staff: 4 by
Program SEIF
booklet A
score
1,2-0
3,4-5
5,6-9
7,8:11
9,10:3
SHED IT 37.5 SD NS NS Student: 14 1,2-1 All M
internet 10.4 Non Acad Staff: 14 3,4-7
program w/ Acad Staff: 6 5,6-3
information 7,8:11
session and 9,10:2
program
booklet (the
program
facilitates self
monitoring
and daily
diary to which
the
researchers
G-167
(continued)
Control
respond)
Taylor, Computer 43.7. SD NS NS NS NS All F
1991 9 Assisted 11.1
Obesity Therapy
1200 calorie
diet (Frozen
Food)
followed by
CAT
Williamson, Control and Mean, 13.2 NS NS NS NR NR NR Height (cm):
10
2006 intervention SD, 1.4 mean, 160.0
adolescents SD, 8.1
Weight (kg):
mean, 93.3
SD, 22.5
BMI:
percentile 98.3
(2.5)
mean, 36.4
SD, 7.9
body fat DXA:
mean, 45.9
SD, 7.5
Control and Mean, 43.2 Height (cm):
intervention SD, 6.2 mean, 162.3
parents SD, 6.9
Weight (kg):
mean, 101.2
SD, 18.4
BMI:
percentile not
reported
mean, 38.4
SD, 7.2
Body fat DXA:
mean, 48.4
SD, 6.3
Womble, Control Mean, 43.3 NS NS NS NR NR NR Height (cm):
11
2004 SD, 11.1 mean, 162.8
SD, 6.3
G-168
(continued)
Control
Weight (kg):
mean, 87.9
SD, 10.8
BP(systolic):
mean,112.1
SD, 13.8
BP (diastolic):
mean, 66
SD, 9.6
Glucose:
mean, 81.5
SD, 21.3
ediets.com Mean, 44.2 Height (cm):
SD, 9.3 mean, 165.5
SD, 6.5
Weight (kg):
mean, 93.4
SD, 12.6
BP (systolic):
mean, 121.7
SD, 16.7
BP (diastolic):
mean, 74.4
SD, 10.1
Glucose:
mean, 90.2
SD, 11.7
C = Caucasian, NS = not specified, NR = not reported, F = female, kg = kilograms, BMI = body mass index, cm = centimeter, BP = blood pressure,
kg/m2 = kilograms per square meter, SD = standard deviation, SES = Socio economic status
Reference List
1. Booth AO, Nowson CA, Matters H. Evaluation of an interactive, Internet-based weight loss program: a pilot study. Health Educ Res 2008; 23(3):371-81.
2. Burnett KF, Taylor CB, Agras WS. Ambulatory computer-assisted therapy for obesity: A new frontier for behavior therapy. 1985; 53(5):698-703.
3. Cussler EC, Teixeira PJ, Going SB et al. Maintenance of weight loss in overweight middle-aged women through the Internet. Obesity (Silver Spring)
2008; 16(5):1052-60.
G-169
(continued)
4. Frenn M, Malin S, Brown RL et al. Changing the tide: An Internet/video exercise and low-fat diet intervention with middle-school students. 2005;
18(1):13-21.
5. Hunter CM, Peterson AL, Alvarez LM et al. Weight management using the internet a randomized controlled trial. Am J Prev Med 2008; 34(2):119-26.
6. Kroeze W, Oenema A, Campbell M, Brug J. The efficacy of Web-based and print-delivered computer-tailored interventions to reduce fat intake: results of
a randomized, controlled trial. J Nutr Educ Behav 2008; 40(4):226-36.
7. McConnon A, Kirk SF, Cockroft JE et al. The Internet for weight control in an obese sample: results of a randomised controlled trial. BMC Health Serv
Res 2007; 7:206.
8. Morgan PJ, Lubans DR, Collins CE, Warren JM, Callister R. The SHED-IT Randomized Controlled Trial: Evaluation of an Internet-based Weight-loss
9. Taylor CB, Agras WS, Losch M, Plante TG, Burnett K. Improving the effectiveness of computer-assisted weight loss. 1991; 22(2):229-36.
10. Williamson DA, Walden HM, White MA et al. Two-year internet-based randomized controlled trial for weight loss in African-American girls. Obesity
(Silver Spring) 2006; 14(7):1231-43.
11. Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of a commercial internet
weight loss program. Obes Res 2004; 12(6):1011-8.
G-170
Evidence table 19. Outcomes in studies addressing the impact of CHI application intermediate outcomes in obesity (KQ1b)
Control Measure Measure Measure at ratios

Author, Measure Measure at time at time final time at
year Outcomes Intervention n at BL at time point 3 point 4 point time Significance
point 2 points
Obesity
Booth, Weight change EX 26 12weeks:
1
2008 (%) mean, 2.1
range,
-2.9-14.2
SD, 3.4
ED 27 12weeks:
mean, 0.9
range, 3.0-
8.6
SD, 2.5
Waist EX 26 12weeks
circumference mean, -4.5
change (cm) range,
-12.5-4.7
SD, 4.5
ED 27 12weeks
mean, -3.2
range,
-8.7-2.2
SD, 2.9
Physical EX 26 Mean, 9151.5 12weeks
activity range, mean,
(daily steps) 3559,16623 12299.6
SD, 3289.9 range,
6214,19246
SD, 3514.7
ED 27 Mean, 8673.3 12weeks
range, mean,
2784,15202 12198.8
SD, 3567.3 range,
6650,22572
SD, 4121.8
Energy intake EX 26 12weeks BL,
mean, 131.1 time point 2,
SD, 759.9 difference between
group p 0.066
G‐171

Evidence table 19. Outcomes in studies addressing the impact of CHI application intermediate outcomes in obesity (KQ1b) (continued)

point 2 points
ED 27 12weeks
mean, -
1812.6
SD, 729.9
Burnett, Short term Paper and 6 Gain of weight: The initial 2 week
1985 2 weight change: pencil 0.67lbs SD period had only
Obesity Baseline 2 wk method of 2.66lbs self monitoring and
period providing instruction to lose
feedback wt given
Computer 6 Gain of weight:

Assisted 0.17lbs SD
method of 0.41lbs
providing
feedback
Short term Paper and 6 Loss of weight: The

weight change: pencil 3.3 lbs SD 3.2 lbs RxÆWithdrawÆRx
Post- baseline method of phase 2 + 2 + 4 wk
8 wk period providing format.
feedback
Computer 6 Loss of weight:

Assisted 8.1 lbs SD 2.7 lbs
method of
providing
feedback
Long term Paper and 6 Loss of Weight: No treatment

weight pencil 4.17 lbs SD 4.83 offered during this
changes (24 method of lbs time
wks) providing
feedback
G‐172


point 2 points
Computer 6 Loss of Weight:
Assisted 15.67lbs SD 10.46
method of lbs
providing
feedback
Long term Paper and 6 Loss of Weight:

weight pencil 2.34 lbs SD 7.31
changes (40 method of
wks) providing
feedback
Computer 6 Loss of Weight:

Assisted 17.67 lbs SD
method of 13.82 lbs
providing
feedback
Self-reported Paper and 6 2076 cal SD 165 1462 cal SD

Caloric intake pencil cal 324 cal
method of
providing
feedback
Computer 6 1942 cal SD 334 1142 cal SD

Assisted cal 323 cal
method of
providing
feedback
Self-reported Paper and 6 77 PA units SD 206 PA units

physical pencil 128 SD 108
method of
G‐173


point 2 points
activity providing
feedback
Computer 6 172 PA units SD 372 PA units

Assisted 188 SD 158
method of
providing
feedback
How beneficial Paper and 6 2.72 SD

will this pencil 0.58
treatment be in method of
promoting providing
weight loss for feedback
you?
Computer 6 2.79 SD
Assisted 0.94
method of
providing
feedback
How beneficial Paper and 6 2.84 SD

will this pencil 0.54
treatment be in method of
promoting providing
weight loss for feedback
overwt indi.?
Computer 6 2.74 SD
Assisted 0.84
method of
providing
G‐174


point 2 points
feedback
Cussler, Weight change Control 59 Mean, -5.2 4-16months:

20083 (kg) SD, 3.8 mean, 1
SD, 4.6
Internet 52 Mean, -5.3 4-16months:
group SD, 3.6 mean, 0.7
SD, 5.4
BMI Control 59 Mean, -1.9 BL-4 4-16months
SD, 1.4 months mean, 1.9
SD, 1.5
Internet 52 Mean, -1.9 BL-4 4-16months
SD, 1.4 months mean, -2.1
SD, 1.4
Exercise Control 59 mean, 144 BL-4 4-16months
energy SD, 151 months mean, 164
expenditure SD, 268
(kcal/day) Internet 52 Mean, 151 BL-4 4-16months
SD, 196 months mean, 123
SD, 265
Energy intake Control 59 Mean, -370 BL-4 4-16months
(kcal/day) SD, 471 months mean, 91
SD, 330
Internet 52 BL- 4-16months BL,
4months mean, 74 time point 2,
SD, 371 change in energy
intake
Frenn, Physical Regular 60 Reduction in
2005 4 Activity Classroom moderate/vigorous
assignments PA by 46 min
Obesity measured by the
log
8 sessions 43 Increase in the PA

Internet by 22 min for
based those completing
G‐175


point 2 points
interactive 2/3 modules and
model based 33 min for those
on HP/TM completing all 3
modules (p=0,05)
Diet Regular 49 Fat intake went

Classroom from 31.5 Æ
assignments 31.6% (Not
significant)
8 sessions 40 Reduced fat

Internet intake from 30.7 to
based 29.9% (p=0,008)
interactive
model based
on HP/TM
Hunter, Body weight Control 222 Mean, 86.6 6months:

5
2008 (kg) SD, 14.7 mean, 87.4
SD, 14.7
BIT 224 Mean, 87.4 6months:
SD, 15.6 mean, 85.5
SD, 15.8
BMI (kg/m2) Control 222 Mean, 29.3 6months
SD, 3 mean, 29.4
SD, 3
BIT 224 mean, 29.4 6months
SD, 3 mean, 28.8
SD, 3.3
Waist Control 222 Mean, 94.2 6months
circumference SD, 10.9 mean, 93.4
(cm) SD, 12.8
BIT 224 Mean, 94.5 6months
SD, 11 mean, 92.2
SD, 11.6
G‐176


point 2 points
Body fat Control 222 Mean, 34.2 6months
percentage SD, 6.9 mean, 34.7
(%) SD, 7
BIT 224 6months
mean, 33.9
SD, 7.3
Kroeze, Total fat intake Control 133 g 1month 6months:
2008 6 mean, mean, 83.0
88.4 SD, 34.2
SD, 39.9
Interactive- 126 g 1 month 6months:
tailored mean, mean, 77.9
condition 77.4 SD, 30.4
SD, 30.9
Print-tailored 124 g 1 month 6months:
condition mean, mean, 76.1
80.5 SD, 26.9
SD, 25.7
Saturated fat Control 133 g 1 month 6months
intake mean, mean, 29.5
31.4 SD, 13.7
SD, 15
Interactive 126 g 1 month 6months
Condition mean, mean, 28.5
28.3 SD, 10
SD, 12.9
Print 124 g 1 month 6months
condition mean, mean, 27.0
28.9 SD, 10
SD, 9.8
Energy intake Control 133 mega joules 1 month 6months
mean, 9.4 mean, 8.9
SD, 3.1 SD, 3
Interactive 126 mega joules 1 month 6months
Condition mean, 8.6 mean, 8.4
SD, 2.5 SD, 2.5
Print 124 mega joules 1 month 6months
G‐177


point 2 points
condition mean, 8.3 mean, 8.2
SD, 2.7 SD, 2.4
McConnon, BMI change at Control 77 kg / m2 12 months
20077 12 months after
(kg/m2) baseline:
range,
-8.1 to +3.5;
Internet 54 kg / m2 12 months
group after
baseline:
range, -
5.9 to 3.8;
Loss of 5% or Control 77 6 months 12 months
more body (%):(18)
weight (12 Internet 54 6 months 12 months
months) group (%): (22)
Using website Internet 54 mean, 53 6 months 12 months
at 6 months, at group (%): (29)
12 months
Never used Internet 54 6 months 12 months
website group (%): (47)
Of those who Internet 54 mean, 63 6 months 12 months
used website, group (%): (85 )
found it easy /
very easy
Of those who Internet 54 mean, 78 6 months 12 months
us website, group (%): (76)
found it clear /
very clear
Morgan, Change in Prog info + 31 Loss of Weight: −3.0 All differences
2009 8 body wt. 3m Booklet gp (−4.5, −1.4) KG statistically
Obesity significant
SHED IT 34 Loss of Weight: −4.8
group (−6.4, −3.3) KG
G‐178


point 2 points
Change in Prog info + 31 Loss of Weight: −3.5
body wt. 6m Booklet gp (−5.5, −1.4)
SHED IT 34 Loss of Weight: −5.3

group (−7.3, −3.3)
Waist Prog info + 31 LOSS: −4.4 (−6.3,

circumference Booklet gp −2.5) CM
(cm) 3m
SHED IT 34 LOSS: −5.2 (−7.1,
group −3.4) CM
Waist Prog info + 31 −5.6 (−7.7, −3.5) CM

circumference Booklet gp
(cm) 6m
SHED IT 34 −7.0 (−9.1, −4.9) CM
group
BMI (kg/m2) 3m Prog info + 31 −0.9 (−1.4, −0.5)

Booklet gp KG/M^2
SHED IT 34 −1.5 (−2.0, −1.0)

group KG/M^2
BMI (kg/m2) 6m Prog info + 31 −1.1 (1.7, −0.5)

Booklet gp
SHED IT 34 −1.6 (−2.2, −1.0)

group
Systolic blood Prog info + 31 −8 (−12, −3) MM HG

pressure 3m Booklet gp
G‐179


point 2 points
SHED IT 34 −6 (−10, −1) MM HG
group
Systolic blood Prog info + 31 −10 (−14, −6)

SHED IT 34 −10 (−14, −7)

group
Diastolic blood Prog info + 31 −6 (−10, −2) MM HG

SHED IT 34 −4 (−8, −1) MM HG

group
Diastolic blood Prog info + 31 −5 (−10, −2)

SHED IT 34 −6 (−11, −1)

group
Resting heart Prog info + 31 −7 (−11, −3) BPM

rate 3m Booklet gp
SHED IT 34 −9 (−12, −5) BPM

group
Resting heart Prog info + 31 −7 (−12, −3) BPM

rate 6m Booklet gp
SHED IT 34 −6 (−11, −2) BPM

group
G‐180


point 2 points
Physical activity Prog info + 31 Went Up by: 976
Booklet gp (−12, 1,965)
(mean STEPS/DAY
steps/day) 3m
SHED IT 34 Went Up by: 1,184
group (234, 2,133)
STEP/DAY
Physical activity Prog info + 31 Went Up by: 1,302

Booklet gp (241, 2,363)
(mean
steps/day) 6m Went Up by: 938
SHED IT 34
group (−90, 1,966)
Energy intake Prog info + 31 Went down by:

(kJ/day) 3m Booklet gp −2,068 (−3,089,
−1,047) KJ/DAY
SHED IT 34 Went down by:

group −3,195 (−4,159,
−2,230) KJ/DAY
Energy intake Prog info + 31 Went down by:

(kJ/day) 6m Booklet gp −1,881 (−3,087,
−676) KJ/DAY
SHED IT 34 Went down by:

group −3,642 (−4,764,
−2,521) KJ/DAY
Taylor, Weight Loss Computer 28 M 3.1 SD 2.2

1991 9 (Post- Assisted (Loss to fu 4,
treatment 12w Therapy (fu therefore 24
Obesity – Pre- 12 wks) subjects analyzed)
G‐181


point 2 points
treatment) 1200 calorie 27 M = 5.3 SD 2.2
diet (Frozen (Loss to fu 1,
Food) therefore 27
followed by subject analyzed)
CAT (fu 12
wks)
Weight Loss Computer 21 M 0.9 SD 3.6

(F/u @ 6m – Assisted
Pre-treatment) Therapy
1200 calorie 25 M 3.8 SD 2.7

diet (Frozen
Food)
followed by
CAT
Williamson, Body weight Control 50 24 month:

10
2006 (kg) mean
A: 6.3
P: 0.06
SD
A: 1.6
P: 0.89
Interactive 47 Mean, 24 month:
nutrition A:93.3 mean,
education P:101 A: 4.4
program and SD, P: 1.1
Internet A: 22.5 SD,
counseling P: 18.4 A: 1.7
behavioral P: 0.91
therapy for
the
intervention
group
G‐182


point 2 points
Body Control 50 BMI 6 month 12 month 18 month 24 month
composition mean,
A: 1.2
P: 0.04
SD
A: .65
P: .34
Interactive 47 Mean, 6 month 12 month 18 month 24 month
bNutrition A:36.4 mean,
education P:38.4 A: 0.73
program and SD, P: 0.55
internet A: 7.9 SD,
counseling P:7.2 A: .66,
behavioral P: 0.34
therapy for
the
intervention
group
Weight loss Control 50 6 month 12 month 18 month 24 month
behavior (body mean,
fat %) A:0.84
P:0.51
SD,
A:0.72
P:0.46
Interactive 47 Mean, 6 month 12 month 18 month 24 month
bNutrition A: 45.9 mean,
education P: 48.4 A:-0.08
program and SD, P:0.36
internet A: 7.5 SD,
counseling P: 6.3 A:0.71
behavioral P:0.46
therapy for
the
intervention
group
BMI (BMI Control 50 6 month 12 month 18 month 24 month
G‐183


point 2 points
percentile) mean,
A: -0.001
SD,
A: 0.003
Interactive 47 6 month 12 month 18 month 24 month
bNutrition mean,
education A: -0.004
program and SD,
internet A: 0.003
counseling
behavioral
therapy for
the
intervention
group
Womble, Weight change Control 16 16weeks 52 weeks:
11
2004 percent (%) mean, 3.6 mean, 4
SD, 4 SD, 5.1
ediets.com 15 16weeks 52 weeks:
mean, 0.9 mean, 1.1
SD, 3.2 SD, 4
Weight change Control 16 16weeks 52 weeks
(kg) mean, 3 mean, 3.3
SD, 3.1 SD, 4.1
ediets.com 15 16weeks 52 weeks
mean, 0.7 mean, 0.8
SD, 2.7 SD, 3.6
BMI = body mass index, BL = baseline, g = gram, kg = kilogram, SD = standard deviation, cm = centimeter, kg/m2 = Kilograms per square meter,
kcal/day = kilocalories per day, A = Adolescents, P = parents
Reference List
1 Booth AO, Nowson CA, Matters H. Evaluation of an interactive, Internet-based weight loss program: a pilot study. Health Educ Res 2008; 23(3):371-81.
G‐184

2 Burnett KF, Taylor CB, Agras WS. Ambulatory computer-assisted therapy for obesity: A new frontier for behavior therapy. 1985; 53(5):698-703.
3 Cussler EC, Teixeira PJ, Going SB et al. Maintenance of weight loss in overweight middle-aged women through the Internet. Obesity (Silver Spring) 2008;
16(5):1052-60.
4 Frenn M, Malin S, Brown RL et al. Changing the tide: An Internet/video exercise and low-fat diet intervention with middle-school students. 2005; 18(1):13-
21.
6 Kroeze W, Oenema A, Campbell M, Brug J. The efficacy of Web-based and print-delivered computer-tailored interventions to reduce fat intake: results of a
randomized, controlled trial. J Nutr Educ Behav 2008; 40(4):226-36.
2007; 7:206.
9 Taylor CB, Agras WS, Losch M, Plante TG, Burnett K. Improving the effectiveness of computer-assisted weight loss. 1991; 22(2):229-36.
(Silver Spring) 2006; 14(7):1231-43.
11 Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of a commercial internet weight
loss program. Obes Res 2004; 12(6):1011-8.
G‐185

Evidence Table 2. Description of RCTs addressing the impact of CHI applications on health care processes (KQ1a)
Year data
Author, under Application duration of Jadad
year study type Location intervention Inclusion criteria Exclusion criteria Control Intervention score
Asthma
Bartholomew, Inner-city Watch, Physician 4 to 15.6 Age 6–17 years, Not speaking Participant Participant
2000 1 elementary Discover, office Moderate-to- English, co-existing assigned to assigned to
and middle Think and severe asthma, disease, usual-care Watch,
school–age Act (An English speaking inadequate reading Discover, Think
6-17 Interactive parents, level, parent and Act
children multimedia No chronic inability to
with application disease other than understand the
moderate on CD- asthma study
to severe ROM)
asthma
Guendelman, Inner-city Personal Home and April 8, Children age 8- 16 Patients involved in Participants Participants
2
2002 children and in an 1999, and years, had an other asthma or using asthma using Health
as having interactive outpatient July 5, 2000 English- drug efficacy diary Buddy
asthma by communicat hospital speaking studies,
a ion clinic. caregiver, had a Involved in
physician. device telephone at research that
(Health home, and were required behavior
Buddy diagnosed as modification,
having persistent Mental or physical
asthma, Patient challenges that
with 2 or more made difficult to
emergency use
department (ED) Health Buddy.
visits and/or at Children with co-
least 1 inpatient morbid conditions
admission that could affect
during the year their quality of life.
before the study
Jan, Individuals Personal Home/ 2004/ 6 - 12 yr, Diagnosed with Verbal Blue Angel for 1
3
2007 interested monitoring residence January to Caregivers have Bronchopulmonary information Asthma Kids
in their own device December Internet access, dysplasia, and booklet
health care persistent asthma Diagnosed with for asthma An Internet-
diagnosis (GINA other chronic co education based diary
Caregiver, clinical practice morbid conditions with written record for peak
childhood guidelines) that could affect asthma diary. expiratory flow
asthma quality of life rate (PEFR)
Symptomatic
support
G-14
Evidence Table 2. Description of RCTs addressing the impact of CHI applications on health care processes (KQ1a) (continued)
Year data
information, and
an action plan
suggestion, and
telecommunicati
on technologies
for uploading
and retrieving
the storage data
Krishna, Individuals Personal Home/ 1999/ NS < 18 yr, Cystic fibrosis, Traditional Internet-enabled 3
20034 interested monitoring residence Confirmed asthma Bronchopulmonary care interactive
in their own device dysplasia, multimedia
health Other chronic lung asthma
disease education
Parents/ program
caregivers
Use of Contraception
Chewining, Individuals Computer- Clinician NS < 20 yr, Standard Computer- 0
19995 interested Based office Female, information Based
in their own Decision ability to read and Interactive
health care Aid understand Decision Aid
English,
Expressed interest
in getting a
contraceptive
Yr = Year, NS = not specified, PEFR = Peak expiratory flow rate
G-15
Evidence Table 2. Description of RCTs addressing the impact of CHI applications on health care processes (KQ1a) (continued)
Reference List
1 Bartholomew LK, Gold RS, Parcel GS et al. Watch, Discover, Think, and Act: Evaluation of computer-assisted instruction to improve asthma self-
management in inner-city children. 2000; 39(2-3):269-80.
2 Guendelman S, Meade K, Benson M, Chen YQ, Samuels S. Improving asthma outcomes and self-management behaviors of inner-city children: A
randomized trial of the Health Buddy interactive device and an asthma diary. 2002; 156(2):114-20.
3 Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, Liu LF. An internet-based interactive telemonitoring system for improving childhood asthma outcomes in
Taiwan. Telemed J E Health 2007; 13(3):257-68.
4 Krishna S, Francisco BD, Balas EA, Konig P, Graff GR, Madsen RW. Internet-enabled interactive multimedia asthma education program: a randomized
trial. Pediatrics 2003; 111(3):503-10.
5 Chewning B, Mosena P, Wilson D et al. Evaluation of a computerized contraceptive decision aid for adolescent patients. Patient Educ Couns 1999;
38(3):227-39.
G-16
Evidence Table 20. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in diabetes (KQ1b)
Year data
CHI collected/
Author, Consumer Application duration of Exclusion Jadad
year under study type Location intervention Inclusion criteria criteria Control Intervention score
Diabetes mellitus
Glasgow, Individuals Personal NS NS Type 2 diabetes for Basic Tailored self- 0.5
20031 interested in monitoring more than 1 year, information management,
their own device Planning to stay in Peer support
health care area for one year,
Meet Wellborn
criteria for type 2
diabetes
Homko, Individuals Interactive Home/ Duration, 18-45 yr, Prior history of Usual care, Telemedicine 1.5
2
2007 interested in consumer residence Sep 2004 to documented GDM glucose paper (website to
their own website May 2006 on 3-h oral glucose intolerance logbooks document
health care tolerance test, using outside of glucose levels
the criteria of pregnancy, and to
Carpenter and multiple gestations communicate
Coustan, with health-
33 weeks gestation care team)
or less
McKay, Individuals Interactive Home/ NS ≥ 40 or > 39 yr, Contraindication Internet Internet Active 2.5
3
2001 interested in consumer residence Type 2 diabetes, to moderate information Lives
their own website physical activity physical activity as only Intervention
health care level below the assessed by the
current minimum Physical Activity
recommendation Readiness
Questionnaire
Richardson, Type 2 Pedometer Home/res NS 18 y/o Type 2 DM, Pregnant women Employing Employing
2007 4 diabetics hooked onto email users w/ and folks who lifestyle structured
Diabetes Interactive Window XP/2000 have used goals for goals that
computer and self reported pedometer in last overall emphasize PA
based moderate PA less 30 days steps using
feedback than 150 min/week. recorded computerized
mechanism English speaking. from the feedback
Interested in pedometer mechanisms
starting a walking
program (cleared by
a physician)
Wangberg, Individuals Interactive NS NS 17-67 yr, Low self- 2
5
2006 interested in consumer Type I or II efficacy
their own website diabetes,
health care Access to the
internet
G-186
Evidence Table 20. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in diabetes (KQ1b) (continued)
Year data
CHI collected/
Author, Consumer Application duration of Exclusion Jadad
year under study type Location intervention Inclusion criteria criteria Control Intervention score
Wise, 1986 Diabetic Interactive Home / Ns Diabetics attending None specified 3 controls Interactive
6
Diabetes individuals computerize Res Charing Cross Used: computerized
both NIDDM d machine hospitaland having a. No machine
and IDDM DM > 2 yrs intervention
(used for
Glucose
control
assessmen
t) No KAP
b. Just the
assessmen
t of the
KAP
c. Take-
away
corrective
feedback
Diabetes, heart disease or chronic lung disease
Lorig, 20067 Individuals Interactive NS NS >18 yr, No cancer Usual care Treatment 1.5
interested in consumer Heart disease or treatment in past
their own website chronic lung year,
health care disease or Type 2 Participated in the
diabetes, small-group
Access to a Chronic Disease
computer with Self-Management
Internet and email Program
capabilities,
Agreed to 1–2
h/week of log on
time spread over at
least 3 sessions/wk
for 6 wk,
Able to complete
the online
questionnaire
h = hours, NS = not specified, yr = year, GDM = Gestational Diabetes Mellitus, wk = week
G-187
Evidence Table 20. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in diabetes (KQ1b) (continued)
Reference List
1 Glasgow RE, Boles SM, McKay HG, Feil EG, Barrera M Jr. The D-Net diabetes self-management program: long-term implementation, outcomes, and
generalization results. Prev Med 2003; 36(4):410-9.
2 Homko CJ, Santamore WP, Whiteman V et al. Use of an internet-based telemedicine system to manage underserved women with gestational diabetes
mellitus. Diabetes Technol Ther 2007; 9(3):297-306.
3 McKay HG, King D, Eakin EG, Seeley JR, Glasgow RE. The diabetes network internet-based physical activity intervention: a randomized pilot study.
Diabetes Care 2001; 24(8):1328-34.
5 Wangberg SC. An Internet-based diabetes self-care intervention tailored to self-efficacy. Health Educ Res 2008; 23(1):170-9.
6 Wise PH, Dowlatshahi DC, Farrant S. Effect of computer-based learning on diabetes knowledge and control. 1986; 9(5):504-8.
7 Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med Care 2006; 44(11):964-71.
G-188
Evidence Table 21. Description of consumer characteristics in studies addressing the impact of CHI applications on intermediate outcomes in diabetes (KQ1b)
Control
Author, Education, Gender Marital
year Interventions Age Race, n (%) Income n(%) SES n (%) Status Other outcomes
Diabetes mellitus
Glasgow, Basic Baseline characteristics not reported
1
2003 information
Tailored self-
management
intervention
Homko, Usual care, Mean, 29.2 White non- USD < 8 yr, 2(8) NR BMI:
2
2007 Paper logbooks SD, 6.7 Hispanic, 6(24) <15,000, 10(40) 8-12 yr, 12(48) mean, 32.5
Black non- 15,000-$34,999, 12-16 yr, 10(40) SD, 7.1
Hispanic, 12(48) 3(12) Gravidity:
Latino/Hispanic, 35,000-$54,999, mean, 2.9
4(16) 3(12) SD, 2.3
API, 3(12) >55,000, 3(12) Glucose challenge
missing, 6(24) (mg/dl):
mean, 179.1
SD, 45.2
GA at diagnosis
(weeks):
mean, 27.7
SD, 3.8
Telemedicine Mean, 29.8 White non- USD < 8 yr, 4(12.5), NR BMI :
(website to SD, 6.6 Hispanic, 8(25) <15,000, 8(25) 8-12 yr, 12(37.5) mean, 33.4
document Black non- 15,000-$34,999, 12-16 yr,15(47) SD, 8.6
glucose levels Hispanic, 14(44) 8(25) gravidity:
and to Latino/Hispanic, 35,000-$54,999, mean, 3
communicate 7(22) 3(9) SD, 1.8
with health- API, 3(9) >55,000, 6(19) glucose challenge
care team) missing, 7(22) (mg/dl):
mean, 159.5
SD, 46.3
GA at diagnosis
(weeks):
mean, 27.5
SD, 4.2
McKay, Internet Mean, 52.3 White non- NS 12-16 yr, (50 ) NR Treatment:
3
2001 information Hispanic, (82) Taking Insulin:
only (22)
Diagnosed with
diabetes for over
one or more co
morbid chronic
G-189
(continued)
Control
disease: (75)
Internet-based NS NS NS NS NR NS
physical activity
intervention
Richardson Employing 52 +- 12 W (76) B (18) O <30K-18 HS DIP/GED: 6 NS M (29)
, 2007 4 lifestyle goals (6) 30-70K-18 Some Coll:47
Diabetes for overall >70K-65 Coll Degree: 18
steps recorded (percent) Grad Degree: 29
from the
pedometer
Employing 53 +-9 W (77) B (8) O <30K-8 HS DIP/GED: 8 NS M (38)
structured (15) 30-70K-31 Some Coll:15
goals that >70K-62 Coll Degree:46
emphasize PA (percent) Grad Degree:31
using
computerized
feedback
mechanisms
Wangberg, Low self- Mean, 37.3 NS NS 8-12 yr, (11) NR F, (63) Type I Diabetes:
5
2006 efficacy range, (72)
33.2–41.4 Insulin use:
(78)
HbA1C:
(7.7)
High self- Mean, 42.9 NS NS 8-12 yr, (8) NR F, (50) Type I Diabetes:
efficacy range, (50)
38.0–47.9 Insulin use: (71)
HbA1C: (7.2)
Wise, 1986 IDDM 42 +/- 16 NS NS NS Sex ratio
6
Diabetes varied
from 0.42
to 0.60.
The
study
does not
specify
any other
detail
Control Group
(AGE +/- SE)
Assessment on 44 +/- 17
G-190
(continued)
Control
KAP
KAP – 45 +/- 16
Feedback –
KAP
KAP – 41 +/- 18
Interactive
computer –KAP
NIDDM 55 +/- 21 NS NS NS Sex ratio
varied
from 0.42
to 0.60.
The
study
does not
specify
any other
detail
Control Group
(AGE +/- SE)
KAP
KAP – 58 +/- 17
Feedback –
KAP
KAP – 56 +/- 16
Interactive
computer –KAP
Lorig , Usual care Mean, 57.6 White non- NS NS NR F, (71.6)
20067 SD, 11.3 Hispanic, (88.7)
Online Mean, 57.4 White non- NS NS NR F, (71.2)

intervention SD, 10.5 Hispanic, (87.3)
F = female, M = male, NS = Not specified, NR = Not reported, SES = Socio economic status, API = Asian/Pacific Islander, mg/dl = milligrams/deciliter,
HbA1c = hemoglobin A1c, yr = year, USD = united states dollar
G-191
(continued)
Reference List
Diabetes Care 2001; 24(8):1328-34.
G-192
Evidence table 22. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in diabetes
Control ratios at
Author, Measure Measure at final time
year Outcomes Intervention n at BL time point points Significance
Diabetes mellitus
Glasgow, Kristal total (Dietary Control Mean, 2.22 10 months:
20031 behavior) SD, 0.45 mean, 2.03
SD, 0.38
Tailored self- Mean, 2.19 10 months:
management SD, 0.46 mean, 1.93
Estimated grams of Control Mean, 44.4 10 months
daily fat (grams) SD, 33.8 mean, 29.8
SD, 14.3
Tailored self- Mean, 40.8 10 months
SD, 14.3
Minutes activity per Control Mean, 26.8 10 months
day (minutes/day) SD, 20.4 mean, 32.1
SD, 22.9
SD, 23
Minutes activity per Control Mean, 66.68 10 months
day SD, 20.66 mean, 79.97
SD, 14.81
SD, 14.81
Guidelines met (% Control Mean, 7.43 10 months
guidelines met) SD, 1.71 mean, 7.67
SD, 1.1
Tailored self- mean, 1.53 10 months
management mean, 7.42
SD, 1.1
Hemoglobin A1C Control Mean, 5.18 10 months:
SD, 1.44 mean, 5.02
SD, 1.17
Tailored self- Mean, 5.7 10 months:
SD, 1.16
Lipid ratio Control Mean, 17.9 10 months
SD, 10.56 mean, 12.93
G‐193

Evidence table 22. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in diabetes (continued)
Control ratios at
SD, 9.11
Tailored self- Mean, 18 10 months
SD, 9.12
CES-D total Control Mean, 4.14 10 months
SD, 1.32 mean, 4.96
SD, 1.12
SD, 1.12
Homko, Self-efficacy (DES) Control 25 Score on DES 37 weeks gestation: NS
20072 mean, 4
SD, 0.5
Telemedicine 32 Score on DES 37 weeks gestation:
mean, 4.4
SD, 0.5
System use (# of sets Control 25 Frequency of monitoring 37 weeks gestation NS
of information sent on (sets of data reported) mean, 73.7
telemedicine system) SD, 56.7
Telemedicine 28 37 weeks gestation
mean, 94.8
SD, 60
FBS Control 25 FBS (mg/dl) 37 weeks gestation NS
mean, 88.6
SD, 9.5
mean, 90.8
SD, 11.8
A1c at time of delivery Control 25 A1c at delivery (%) 37 weeks gestation NS
mean, 6.2
SD, 2.2
mean, 6.1
SD, 0.8
McKay, Moderate-to-vigorous Control 33 Mean, 7.3 8 weeks
3 exercise Unadjusted SD, 6.2 mean, 18
2001
(minutes/day) SD, 17.3
Internet-based 35 Mean, 5.6 8 weeks
physical SD, 6.2 mean, 17.6
G‐194

Control ratios at
activity SD, 15.3
intervention
Walking Unadjusted Control 33 Mean, 8.4 8 weeks
(minutes/day) SD, 8.4 mean, 16.8
SD, 22.8
activity SD, 9.5
intervention
Depressive symptoms Control 33 Mean, 17.6 8 weeks
SD, 10.4 mean, 19.9
SD, 14.2
activity SD, 12.5
intervention
Richardson, Total Step Employing 17 4,157 ± 1,737 stps 6,279 ± 3,306 Diff: Ns
4
2007 lifestyle goals 2,122 ±
Diabetes for overall 3,179
steps
recorded from
the pedometer
Employing 13 5,171 ± 1,769 6,868 ± 3,751 Diff: NS

structured 1,697 ±
goals that 3,564
emphasize PA
using
computerized
feedback
mechanisms
Bout Steps Employing 17 286 ± 599 2,070 ± 2,814 1,783 ± S

lifestyle goals 2,741
for overall
steps
G‐195

Control ratios at
recorded from
the pedometer
Employing 13 516 ± 801 (NS from above) 2,616 ± 2,706 (NS diff 2,101 ± S
lifestyle goals from above) 2,815
for overall (NS Diff
steps from
recorded from above)
the pedometer
Satisfaction Employing 17 100%

lifestyle goals
for overall
steps
recorded from
the pedometer
Employing 13 62% P =0.006

lifestyle goals
for overall
steps
recorded from
the pedometer
Usefulness Employing 17 71%

lifestyle goals
for overall
steps
recorded from
the pedometer
Employing 13 31% P = 0.03

lifestyle goals
for overall
steps
G‐196

Control ratios at
recorded from
the pedometer
Adherence (Likelihood Employing 17 (3)

of wearing a lifestyle goals
pedometer) for overall
steps
recorded from
the pedometer
Employing 13 (15) P < 0.001

lifestyle goals
for overall
steps
recorded from
the pedometer
Adherence (Mean Employing 17 16.5h

hours of wearing a lifestyle goals
pedometer) for overall
steps
recorded from
the pedometer
Employing 13 14.5h P = 0.038

lifestyle goals
for overall
steps
recorded from
the pedometer
Wangberg, Summary of Diabetes Low self- 15 Mean, 29.47 1 month - analyzed:

5 Self Care Activities efficacy SD, 9.49 mean, 30.60
2006
SD, 8.92
High self- 14 Mean, 27.64 1 month - analyzed:
G‐197

Control ratios at
efficacy SD, 8.55 mean, 32.07
SD, 7.5
Perceived competence Low self- 15 Mean, 52.20 1 month - analyzed
scale efficacy SD, 13.19 mean, 49.73
SD, 14.18
High low self- 14 Mean, 52.07 1 month - analyzed
efficacy SD, 10.66 mean, 49.93
SD, 10.83
Wise, 1986 6 IDDM Patients
Diabetes Knowledge Index (KAP Assessment of 24 Knowledge Score: 79 SE 2 82 SE 2 Ns

Questionnaire) 4— KAP only
6mo
Assessment + 22 78 SE 2 83 SE 3 significant
Feedback
Assessment + 20 77 SE 2 83 SE 2 Significant
Interactive
computer
NIDDM Patients
Knowledge Index (KAP Assessment of 22 Knowledge UNS UNS Ns

Questionnaire) 4— KAP only
6mo
Assessment + 24 64 SE 2 73 SE 2 significant
Feedback
Interactive
computer
IDDM Patients
G‐198

Control ratios at
Knowledge Index (KAP Control 20 HBA1c: 8.9% 8.8% NS
Questionnaire) 4—
6mo
Assessment of 24 9.1 SE 0.2 8.4 SE 0.1 Significant

KAP only
Assessment + 22 9.3 SE 0.5 8.1 SE 0.4 significant

Feedback
Assessment + 20 9.3 SE 0.2 8.6 SE 0.3 Significant

Interactive
computer
NIDDM Patients
Knowledge Index (KAP Control 21 HBA1c: 8.7% 8.5% NS

Questionnaire) 4—
6mo
Assessment of 22 9.6 SE 0.4 8.8 SE 0.3 Significant

KAP only

Feedback

Interactive
computer

Lorig, 20067 Change in health Control 426 CHANGE in score on 12 months: 0.-13 (ANCOVA)
distress (0-5) Health Distress Scale mean, -0.193 0.025 (repeated
SD, 1.07 measures)
Online 354 CHANGE in score on 12 months:
intervention Health Distress Scale mean, -0.377
G‐199

Control ratios at
SD, 1.11
Change in self Control 426 0-5 scale 12 months 0.340 (logistic)
reported global mean, -0.068 0.514 (repeated
health(0-5) SD, 0.645 measures)
Online 354 12 months
intervention mean, -0.102
SD, 0.768
Change in illness Control 426 1-7scale 12 months 0.704 (ANCOVA),
intrusiveness mean, -0.064 0.061 (repeated
SD, 0.926 measures)
SD, 1.023
Change in disability Control 426 0-3 Scale 12 months BL, 0.051
mean, -0.142 (ANCOVA) 0.335
SD, 0.32 repeated
Online 354 12 months measures
SD, 0.345
Change in fatigue Control 426 0-10scale 12 months:
mean, -0.358
SD, 2.09
Online 354 12 months:
SD, 2.14
Change in pain Control 426 0-10 scale 12 months
mean, -0.047
SD, 2.46
SD, 2.72
Change in shortness of Control 426 0-10 scale 12 months
breath mean, -0.216
SD, 2.4
SD, 2.41
Change in self-efficacy Control 426 1-10 Scale 12 months:
mean, 0.200
G‐200

Control ratios at
SD, 1.82
Online 354 1-10 Scale 12 months:
intervention mean, 0.406
SD, 1.98
FBS = fasting blood sugar, DES = Diabetes Empowerment Scale, BL = baseline, NS = not significant, mg/dl = milligrams/deciliter
Reference List
Diabetes Care 2001; 24(8):1328-34.
G‐201

Evidence table 23. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in mental health
Year data
Depression/anxiety
Christensen, Individual Interactive NS NS ≥18 yr, >52 yr, Control Mood GYM, 2
20041 interested consumer Internet access, receiving clinical Blue Pages
in their own website 22 or higher on the care from either a
health care Kessler psychologist or
psychological psychiatrist
distress scale
Neil, Depressed/ Interactive School – 2006-07 Adolescents 13 – 17 NS Use of Use of
2009 Anxious consumer classroom yrs completing the website website
2
youth website / YouthMood project (open (open
community access) in access) in
community classroom
Proudfoot, Individual Computerized Clinician NS 18-75 yr, Active suicidal Treatment Computerize 3
20043 interested cognitive office Depression, ideas, as usual d therapy
in their own behavioral Anxiety and Diagnosis of
therapy
health care depression, psychosis or
Anxiety, organic mental
Not currently disorder,
receiving any form of alcohol and/or
psychological drug dependence,
treatment or Medication for
counseling, anxiety and/or
Score of 4 or more depression
on the 12 item continuously for 6
general health months or more
questionnaire, immediately prior
12 or more on the to entry,
computer version of Unable to attend 8
the Clinical Interview sessions at the
Schedule-Revised surgery,
Unable to read or
write English
Warmerdam, Depressed Interactive Home / res 08-09/06 – >18 yrs, Score of CES-D scores Wait-listed Interactive
2008 / Anxious Consumer 01-02/07 >=16 on CES-D, greater than 32 controls computer tool
4
website knew Dutch, internet based on
and email access Cog. Beh.
Theory and
Prob. Sol.
Theory
Phobia
G-202
Evidence table 23. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in mental health (continued)
Year data
Schneider, Individual Web based Home/ NS Fulfill ICD-10 criteria Current psychotic Managing 1
20055 interested tailored self residence, for agoraphobia illness, Anxiety
in their own help Remote with/without panic suicide plans, application,
health care information location: disorder, social no severe
preferred phobia or specific depression, Fear Fighter
site of phobia, 4≥ for global disabling cardiac application
patient phobia, or respiratory
Main goal negotiated disease,
and set with On
clinician, benzodiazepine or
phobia for more than diazepam
one year, equivalent dose of
Men: alcohol <21 >5 mg/day,
units/week, began or changed
Women: alcohol <14 dose or type of
units/week, antidepressant
No reading disorder within the last 4
hindering net use weeks,
Substance abuse,
Failed past
exposure therapy
of >4 sessions
Stress
Chiauzzi, Interactive University 2005 ≥18 and ≤24 yr, A control MyStudentBo 0
20086 consumer college students, website dy–Stress
website, scoring above 14 on (CW) website,
the
No treatment
control (NTX)
Hasson, Individual Personal NS NS Employment at a those who quit Access to Web-based 2
7
2005 interested monitoring company insured by employment prior web-based tool with
in their own device Alecta (occupational to completion of tool control group
health care pension plan study, components
company) "communication plus self-help
related problem" with stress
management
exercises
and chat
Stress Management
Zetterqvist, For stress Interactive Home / res 04/2000 – No specified inclusion or exclusion criteria Control Interactive
G-203
Evidence table 23. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in mental health (continued)
Year data
2003 manageme consumer 06-07/2000 unless the participant expressed a self help
8
nt for gen web condition that would prevent him / her stress
population from completing the study management
program
NS = not specified, Yr = year
Reference List
1. Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet: randomised controlled trial. BMJ 2004; 328(7434):265.
2. Neil AL, Batterham P, Christensen H, Bennett K, Griffiths KM. Predictors of adherence by adolescents to a cognitive behavior therapy website in school and
community-based settings. J Med Internet Res 2009; 11(1):e6.
3. Proudfoot J, Ryden C, Everitt B et al. Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care:
randomised controlled trial. Br J Psychiatry 2004; 185:46-54.
4. Warmerdam L, van Straten A, Twisk J, Riper H, Cuijpers P. Internet-based treatment for adults with depressive symptoms: randomized controlled trial. J
5. Schneider AJ, Mataix-Cols D, Marks IM, Bachofen M. Internet-guided self-help with or without exposure therapy for phobic and panic disorders.
Psychother Psychosom 2005; 74(3):154-64.
6. Chiauzzi E, Brevard J, Thurn C, Decembrele S, Lord S. MyStudentBody-Stress: an online stress management intervention for college students. J Health
Commun 2008; 13(6):555-72.
7. Hasson D, Anderberg UM, Theorell T, Arnetz BB. Psychophysiological effects of a web-based stress management system: a prospective, randomized
controlled intervention study of IT and media workers. BMC Public Health 2005; 5:78.
8. Zetterqvist K, Maanmies J, Str+¦m L, Andersson G. Randomized controlled trial of internet-based stress management. 2003; 32(3):151-60.
G-204
Evidence Table 24. Description of consumer characteristics studies addressing the impact of CHI applications on intermediate outcomes in mental health
Control
Author, Race, Education, Gender, Marital Status,
year Interventions Age n(%) Income n(%) SES n(%) n(%) Other
Depression/anxiety
Proudfoot, Usual care Mean, Bangladeshi, 0-10 yr, 17(14) M, 32(25) Single, 33(26) Previous computer
20041 43.4 1(1) 11-12 yr, 28(23) F, 96(75) Married, 54(43) use
SD, 13.7 Black Caribbean, 13-15 yr, 30(25) Cohabiting, No, 23(18)
4(4) >15 yr, 46(38) 11(9) Yes, 103(82)
Indian, 3(3) Separated, 7(6)
Pakistani, 1(1) Divorced,15(12)
White,100(87) Widowed, 5(4)
Internet Mean, Black African, 1(1) <5 yr, 1(1) M, 40(27) Single, 35(25)
therapy 43.6 Black Caribbean, 11-12 yr, 34(24) F,106(73) Married, 60(43)
SD, 14.3 2(2) 13-15 yr, 31(22) Cohabiting,
Black other, 3(2) >15 yr, 58(41) 16(11)
White, 120(90) Separated, 4(3)
Divorced,18(13)
Widowed, 8(6)
Christensen, Control Mean, Mean, 14.4 F,124(70) Married Kessler psychological
2
2004 36.29 SD, 2.3 M, 54(30) Cohabiting, distress scale,
SD, 9.3 100(56) mean, 18
Divorced/ SD, 5.7
separated, Center for
24(14) Epidemiologic studies
Never married, depression score,
53(36) mean, 21.6
SD, 11.1
Mood gym Mean, Mean, 14.6 F,136(75) Married/ Kessler psychological
35.85 SD, 2.4 M, 46(25) cohabiting, distress scale,
SD, 9.5 98(54) mean, 17.9
Divorced/ SD, 5
separated, Center for
26(14) Epidemiologic Studies
Never married, depression scale,
57(31) mean, 21.8
SD, 10.5
Blue Pages Mean, Mean, 15 F,115(69) Married/ Kessler psychological
37.25 SD, 2.4 M, 50(31) cohabiting, distress scale,
SD, 9.4 100(61) mean, 17.5
Divorced/ SD, 4.9
separated,
24(15) Center for
Never Married, Epidemiologic Studies
G-205
Evidence Table 24. Description of consumer characteristics studies addressing the impact of CHI applications on intermediate outcomes in mental health (continued)
Control
53(30) depression scale,
mean, 21.1
SD, 10.4
Neil, Use of 13 – 17 NS 5223/720 (19) rural area (N
2009 website (open yrs 7F 1396)
3
access) in 72% (66) depressed (N
community 4734)
Use of 597/1000 (19) from rural area (N
website (open F (59.7) 193)
access) in (29) depressed (N
classroom 287)
Warmerdam, Wait-listed 44.1 NS Paid Lower: 9 (10.3) NR 69 (79.3)
4
2008 controls (87) Jobs w/: Middle: 28
49 (58.3) (32.2)
Higher: 50
(57.5)
Interactive 45.7 43 (52.4) Lower: 9 (10.2) 61 (69.3)
computer tool Middle: 26
based on (29.5)
Cog. Beh. Higher: 53
Theory (88) (60.2)
Interactive 45.1 43 (50.6) Lower: 5 (5.7) 57 (64.8)
computer tool Middle: 18
based on (20.5)
Prob. Sol. Higher: 65
Theory (88) (73.9)
Phobia
Schneider, Control NS NS NS NS NR NS
5
2005 Computer NS NS NS NS NR NS
aided
cognitive
behavior
therapy with
self-help
exposure
Stress
Chiauzzi, A control Range, White non- NS Yr in School(n), NR M, 40
20086 website(CW), 18-24 Hispanic, 48 First, 29 F, 43
black non- Second, 18
Hispanic, 12 Third, 19
G-206
Control
Latino/Hispanic, 9 Fourth,17
API,(16)
Other 7
MyStudent Range, White non- NS Yr in School(n), NR M, 34
Body–Stress 18-24 Hispanic, 44 First, 30 F, 44
website Black non- Second, 16
Latino/Hispanic, 5 Fourth, 13
API, 14
Other, 7
NTX Range, White non- NS Yr in school (n), NR M, 42
18-24 Hispanic, 50 First, 23 F, 36
Black non- Second, 19
Latino/Hispanic, 8 Fourth, 24
API, 13
Other, 8
Hasson, Access to NS NS USD 8-12 yr, 89(51) NR M, Married, 134(77)
7
2005 web-based <25,000, 12-16yr, 83(48) 112(64) Single, 38(22)
tool including 39(22) F, 62(36)
monitoring 25,000-
tool for stress 40,000,
and health; 106(61)
diary >40,000,
connected to 27(16)
monitoring
tool, and
scientific info
on stress and
health
NS NS USD 8-12yr, 54(42) NR M, 75(58) Married, 102(79)
<25,000, 12-16yr,73(57) F, 54(42) Single, 25(19)
24(18)
25,000-
40,000,
76(59)
>40,000,
27(21)
Stress Management
Zetterqvist, Control Group 38.7 (26— NS Work Student: 5 (12) NS M: 14/40 Civil No. of
G-207
Control
2003 8 60) hours per Work: 33 (83) (35%) Standing: children:
week: Unemployed: 2 Single: Mean:
36.3 (0— (5) 14 (35) 0.98 (0—
60) Living 4)
with
partner: 9
(23)
Married:
17 (43)
Self Help for 40.0 (24— Mean: Student: 5 (22) M: 10/23 Single: 8
stress 56) 29.6 (0— Work: 15 (65) (43%) (35)
management 60) Unemployed:3 Living
via internet (13) with
partner: 6
(26)
Married:
9 (39)
NR = Not reported, M = male, F = female, AIAN = American Indian/Alaska Native, API = American/Pacific Islander, SD = standard deviation,
SES= Socioeconomic Status, USD = United States Dollar
Reference List
G-208
Commun 2008; 13(6):555-72.
G-209
Evidence Table 25. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in mental health
Control Measure at Measure Measure Measure at Ratios at Significances

Author, Measure time point 2 at time at time final time time
year Outcomes Intervention n at BL point 3 point 4 point points
Depression/anxiety
Proudfoot, Depression Control 109 BDI 6 Month: 0.0006
20041 (BDI) mean,16.2
SD, 10.1
Computerized 112 BDI 6 Month: 0.0006
Therapy mean, 11.6
SD, 9.6
Anxiety (BAI) Control 110 BAI 6 Month 0.06
mean, 12.8
SD, 9.1
Computerized 115 BAI 6 Month 0.06
Therapy mean, 10.6
SD, 8.4
Work and Control 110 6 Month
Social mean, 13.4
Adjustment SD, 8.6
scale computerized 115 6 Month
therapy mean, 10
SD, 7.8
ASQ,CoNeg Control 106 6 Month
mean, 84.1
SD, 13.6
Computerized 106 6 Month
therapy mean, 73.7
SD, 15.3
ASQ,CoPos Control 106 6 Month:
mean, 82.8
SD, 12.5
Computerized 108 6 Month:
therapy mean, 87.6
SD, 13.5
Neil, 2009 2 Depression Use of 7207 5.46 SD 2.42
score (Pre- website (open
test) access) in
community
Use of 1000 2.62 SD 2.42

website (open
G‐210

Evidence Table 25. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in mental health (continued)

access) in
classroom
Anxiety (Pre- Use of 7207 5.50 SD 2.59

test) website (open
access) in
community
Use of 1000 2.51 SD 2.44

website (open
access) in
classroom
Warpy Use of 7207 3.16 SD 0.71

thoughts score website (open
access) in
community
Use of 1000 2.58 SD 0.65

website (open
access) in
classroom
No. of Use of 7207 3.10 SD 3.85 P < 0.001

exercises website (open
completed (0— access) in
28) community
Use of 1000 9.38 SD 6.84

website (open
access) in
classroom
Warmerda, Depression Wait-listed 87 32.1 (9.3) 25.6 (9.9) 25.2 (9.9) 25.8 (10.4) Significant
improvement
G‐211


2008 3 (CES – D) controls (87) with time.
Yellow
Interactive 88 31.2 (9.3) 22.9 (10.6) 19.4 17.9 (11.7) indicates
computer tool (11.3) significant
based on difference
Cog. Beh.
Theory (88)
Interactive 88 31.9 (9.3) 20.6 (11.2) 20.6 18.4 (12.1)

computer tool (11.3)
based on
Prob. Sol.
Theory (88)
Anxiety using Wait-listed 87 11.3 (3.6) 8.9 (3.9) 9.0 (3.8) 8.9 (4.0) Significant
HADS controls (87) improvement
with time.
Interactive 88 10.6 (3.6) 7.8 (4.1) 6.7 (4.4) 6.6 (4.5) Yellow
computer tool indicates
based on significant
Cog. Beh. difference
Theory (88)
Interactive 88 10.2 (3.6) 7.1 (4.3) 6.9 (4.4) 6.6 (4.7)

computer tool
based on
Prob. Sol.
Theory (88)
QoL using Wait-listed 87 0.59 (0.18) 0.69 (0.27) 0.65 0.66 (0.27) Significant
EQ5D controls (87) (0.27) improvement
with time.
Interactive 88 0.64 (0.18) 0.68 (0.27) 0.73 0.76 (0.27) Yellow
computer tool (0.27) indicates
based on significant
G‐212


Cog. Beh. difference
Theory (88)
Interactive 88 0.59 (0.18) 0.73 (0.27) 0.73 0.76 (0.27)

based on
Prob. Sol.
Theory (88)
Depression Wait-listed 87 E: 0 (0.0) E:0 (0.0) E: 0 (0.0) Brackets is %

(CES – D) controls (87)
Proportion O: 10 (14.1) O: 15 O: 9 (14.3)
reaching (21.1)
clinically
significant Interactive 88 E: 0 (0.0) E: 26 E: 34 (38.6)
change computer tool (29.5)
based on O: 11 (18.0) O: 18 (39.1)
Cog. Beh. O: 21
Theory (88) (41.2)
Interactive 88 E: 18 (20.5) E: 18 E: 30 (34.1)

based on O: 19 (36.5) O: 17 (40.5)
Prob. Sol. O: 20
Theory (88) (39.2)
Christensen, Center for Control 159 Mean score 6 weeks:

20044 Epidemiologic point mean, 1.1
depression improvement SD, 8.4
scale over baseline
mean, 21.6
SD, 11.1
Blue Pages: 136 Mean score 6 weeks:
Computer point mean, 3.9
based psycho improvement SD, 9.1
education over baseline
G‐213


website mean, 21.1
offering SD, 10.4
information
about
depression
Mood GYM: 136 Mean score 6 weeks:
based improvement SD, 9.1
Cognitive over baseline
Behavior mean, 21.8
therapy SD, 10.5
Automatic Control 159 Mean score 6 weeks
thoughts point mean, 3.1
improvement SD, 15.8
over baseline
Blue Pages: 136 Mean score 6 weeks
website
offering
information
about
depression
Mood GYM: 136 Mean score 6 weeks
Cognitive over baseline
Behavior
therapy
Medical Control 159 Mean score 6 weeks
literacy point mean, -0.1
improvement SD, 0.5
over baseline
Computer point mean, -0.6
website
G‐214


Offering
information
about
depression
cognitive over baseline
behavior
therapy
Psychological Control 159 Mean score 6 weeks
literacy point mean, -0
improvement SD, 0.9
over baseline
Blue Pages: 136 6 weeks
Computer mean, -0.7
based psycho SD, 1.1
education
website
offering
information
about
depression
Mood GYM: 136 6 weeks
Computer mean, -0.5
based SD, 1
cognitive
behavior
therapy
Lifestyle Control 159 Mean score 6 weeks:
literacy point mean, 0.1
improvement SD, 1.6
over baseline
Blue Pages: 136 Mean score 6 weeks:
based psycho improvement SD, 2
website
offering
G‐215


information
about
Depression
Mood GYM: 136 Mean score 6 weeks:
Computer point mean, -0
behavior
therapy
Cognitive Control 159 Mean score 6 weeks
behavior point mean, 0.1
therapy literacy improvement SD, 1.6
over baseline
based psycho improvement SD, 2
website
offering
information
about
depression
Computer point mean, -2
behavior
therapy
Phobia
Schneider, Main Control 13 Mean, 7.2 Week 10 Week 14:
5
2005 problem(self- SD, 1.4 mean, 4.9 mean, 4.9
rating) SD, 2 SD, 1.7
Computer 31 Mean, 7 Week 10 Week 14:
aided SD, 1.2 mean, 4.7 mean, 4.1
cognitive SD, 2 SD, 2.1
behavior
therapy with
self-help
exposure
G‐216


Main goal(self- Control 13 Mean, 7.3 Week 10 Week 14
rating) SD, 1.6 mean, 4.8 mean, 5
SD, 2 SD, 1.9
Computer 31 Mean, 7 Week 10 Week 14
aided SD, 1.2 Mean, 4.5 mean, 4.2
cognitive SD, 2.4 SD, 2.2
behavior
therapy with
self-help
exposure
Stress
Chiauzzi, Perceived Control 78 7 months 0.77
20086 Stress Scale MyStudent 77 7 months
Body–Stress
website
No treatment 80 7 months
control (NTX)
Hasson, Self rated Control 156 Changes in self 6 month Time*group
7
2005 stress rated measures follow-up: effect= .001
management and biological mean,
markers SD,
covariate for
baseline scores
Web-based 121 Changes in self 6 month Time*group
stress rated measures follow-up: effect= .001
management and biological mean,
system markers SD,
covariate for
baseline scores
Self rated Control 156 Changes in self 6 month Time*group
sleep quality rated measures follow-up effect=.04
and biological
markers
covariate for
baseline scores
stress rated measures follow-up effect=.04
management and biological
system markers
G‐217


covariate for
baseline scores
mental energy rated measures follow-up effect= .002
and biological
markers
covariate for
baseline scores
stress rated measures follow-up effect: .002
system markers
covariate for
baseline scores
concentration rated measures follow-up effect: .038
ability and biological
markers
covariate for
baseline scores
Web-based 121 6 month BL,
stress follow-up Time*group
management effect: .038
system
social support rated measures follow-up effect: .049
and biological
markers
covariate for
baseline scores
system markers
covariate for
baseline scores
Biological Control 156 Changes in self 6 month Time*group
marker: rated measures follow-up effect: .04
dehydroeoiand and biological
G‐218


osterone markers
sulphate covariate for
baseline scores
system markers
covariate for
baseline scores
Nero peptide Control 156 Changes in self 6 month Time*group
rated measures follow-up effect: .002
and biological
markers
covariate for
baseline scores
stress rated measures follow-up effect= .002
system markers
covariate for
baseline scores
Chromogranin Control 156 Changes in self 6 month Time*group
rated measures follow-up effect: .001
and biological
markers
covariate for
baseline scores
system markers
covariate for
baseline scores
Stress
Zetterqvist, Perceived Control 40 M 33.17 SD M 28.88 SD Significant
2003 8 Stress Scale 3.76 7.02 difference
Interactive 23 32.91 SD 6.08 24.48 SD
G‐219


self help 7.17
stress
management
program
Hospital Control 40 23.23 SD 5.85 18.70

Anxiety and SD7.64
Depression
Scale HADS

self help 7.09
stress
management
program
Anxiety Control 40 13.85 SD 4.12 11.10 SD

5.05

self help 4.50
stress
management
program
Depression Control 40 9.38 SD 3.07 7.60 SD

3.13

self help 3.14
stress
management
program
G‐220


LE (Life Control 40 1.55 SD 1.22 1.60 SD
Events) 1.28
(Holmes and
Rahes Scale)

self help 1.38
stress
management
program
Perceived Control 40 9.80 SD 3.45 9.62 SD

Social Support 3.62
PS-family

self help 3.63
stress
management
program
Perceived Control 40 9.40 SD 3.26 9.82 SD

Social Support 3.99
PS-friends

self help 4.01
stress
management
program
BL = baseline, SD = standard deviation, BDI = Beck Depression Inventory, BAI = Beck Anxiety Inventory, ASQ C0Neg/CoPos = Attribution Style Questionnaire, composite
index for negative/positive situations
G‐221

Reference List
Commun 2008; 13(6):555-72.
G‐222

Evidence Table 26. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in asthma and COPD (KQ1b)
Year data
Asthma
Jan , Individuals Personal Home/ 2004/ 6 - 12 yr, Diagnosed with Verbal Blue Angel for 1.5
20071 interested monitoring residence January to Caregivers have bronchopulmonary information Asthma Kids
health care Persistent asthma Diagnosed with other for asthma An Internet-
diagnosis (GINA chronic co morbid education based diary
Caregiver, clinical practice conditions that could with written record for peak
childhood guidelines) affect quality of life asthma expiratory flow
asthma diary. rate
Symptomatic
support
information, and
an action plan
suggestion, and
telecommunicati
on technologies
for uploading
and retrieving
the storage data
Joseph, Individuals Interactive Remote NS 9-11 grade, Generic Tailored website 2.5
2
2007 interested consumer location: asthma
in their own website school Current asthma website
health care
Krishna, Individuals Personal Home/ 1999/ NS <18 yr, Cystic fibrosis, Traditional Internet-enabled 1
3
2003 interested monitoring residence Confirmed asthma Bronchopulmonary care interactive
in their own device dysplasia, multimedia
health Other chronic lung asthma
disease education
Caregiver: program
Parents/
caregivers
COPD
Nguyen, Individuals Interactive Academic 2005 Diagnosis of COPD Any active Face-to-face Internet-based 2.5
4
2008 interested consumer medical and being clinically symptomatic illness, (fDSMP) (eDSMP)
in their own website centers stable for at least 1 Participated in a
health care month, pulmonary
Spirometry results rehabilitation
showing at least program in the last
mild obstructive 12 months,
G-223
Evidence Table 26. Description of RCTs addressing the impact of CHI applications on intermediate outcomes in asthma and COPD (KQ1b) (continued)
Year data
disease, Were currently
ADL limited by participating in > 2
dyspnea, days of supervised
Use of the Internet maintenance
and/or checking exercise
email at least once
per week with a
windows operating
system,
Oxygen saturation
> 85% on room air
or ¡Ü 6 L/min of
nasal oxygen at the
end of a 6-minute
walk test
NS = not specified, yr = year, PEFR = Peak expiratory flow rate, COPD = Chronic obstructive pulmonary disease, ADL = Activities of daily living, eDSMP = Internet
based dyspnea self-management programs, fDSMP = face-to-face dyspnea self-management programs, min = minutes
Reference List
1. Jan RL, Wang JY, Huang MC, Tseng SM, Su HJ, Liu LF. An internet-based interactive telemonitoring system for improving childhood asthma outcomes in
2. Joseph CL, Peterson E, Havstad S et al. A web-based, tailored asthma management program for urban African-American high school students. Am J Respir
Crit Care Med 2007; 175(9):888-95.
Notes: CORPORATE NAME: Asthma in Adolescents Research Team
3. Krishna S, Francisco BD, Balas EA, Konig P, Graff GR, Madsen RW. Internet-enabled interactive multimedia asthma education program: a randomized
Notes: CORPORATE NAME: Randomized trial
4. Nguyen HQ, Donesky-Cuenco D, Wolpin S et al. Randomized controlled trial of an internet-based versus face-to-face dyspnea self-management program
for patients with chronic obstructive pulmonary disease: pilot study. J Med Internet Res 2008; 10(2):e9.
G-224
Evidence Table 27. Description of consumer characteristics in studies addressing the impact of CHI applications on intermediate outcomes in asthma and COPD (KQ1b)
Control
Author, Gender, Other
year Interventions Age Race, n (%) Income Education, n (%) SES n (%) characteristics
Asthma
Jan, Verbal Mean, 9.9 NS NS Education of primary NR M, 28(36.8) History of asthma
1
2007 information SD, 3.2 caregiver: F, 48(63.2) (yr):
and booklet HS diploma or below, mean, 2.1
for asthma 43 (56.6) SD, 1.2
education College or above, Asthma severity:
with written 33 (43.4) mild, 33(43.4)
asthma diary moderate, 35(46.1)
severe, 8(10.5)
Participants Mean, 10.9 Education of primary M, 35(39.7) History of asthma
received SD, 2.5 caregiver: F, 53(60.2) (yr):
asthma HS diploma or below, mean, 2.4
education and 58(66.0) SD, 1.9
with College or above, Asthma severity:
interactive 30 (34.0) mild, 33(37.5)
asthma moderate, 43(48.9)
monitoring severe, 12(13.6)
system
Joseph, Generic Mean, 15.3 NS USD NS NR F, 199 (63.4)
2
2007* asthma SD, 1 mean, 12,049
website SD, 2,442
Tailored
website
Krishna, Traditional Range, 0-17 White non- NS Preschool/none: NR M, 76 (62.8)
†3
2003 care yr Hispanic, 102(84.3) 58 (47.9) F, 45 (37.2)
Black non- Kindergarten: 6(5)
Hispanic, 9(7.4) Elementary: 27(22.3)
AIAN, 7(5.8) Jr High 24 (19.8)
Other, 3 High School 6 (5)
Internet- Range, 0-17 White non- Preschool/none: 48 M, 72 (67.3)
enabled yr Hispanic, 93(86.9) (44.9) F, 35 (32.7)
interactive Black non- Kindergarten: 12(11.2)
multimedia Hispanic, 10(9.3) Elementary: 23 (21.5)
asthma AIAN, 2(1.9) Jr High 19 (17.6)
education Other, 2(1.9) High school 5 (4.1)
program
COPD
Nguyen, Face-to-face Mean, 70.9 White non- NS 12-16 yr, 8(40) Not currently F, 9 (45) Currently smoking:
20084 (fDSMP), SD, 8.6 Hispanic, 20(100) >16yr, 12(60) employed or 1 (5)
currently
disabled or
G-225
Evidence Table 27. Description of consumer characteristics in studies addressing the impact of CHI applications on intermediate outcomes in asthma and COPD (KQ1b)
(continued)
Control
Author, Gender, Other
year Interventions Age Race, n (%) Income Education, n (%) SES n (%) characteristics
retired:
15 (75)
eDSMP Mean, 68 White non- 12-16 yr, 10(50) Not currently F, 8(39) Currently smoking:
SD, 8.3 Hispanic, 18 (95) >16yr, 9(50) employed or 2 (11)
currently
disabled or
retired:
13 (72)
* Consumer characteristics were not stratified by intervention

† Education of caregiver was not reported
NS = not specified, SES = Socioeconomic Status, F = female, M = male, AIAN = American Indian/Alaska Native, Yr = year, SD = standard deviation, NR= Not Reported
USD = United States dollar, eDSMP = Internet-based dyspnea self-management programs, fDSMP = face to face dyspnea self management programs
Reference List
Crit Care Med 2007; 175(9):888-95.
G-226
Evidence Table 28. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes of asthma and COPD (KQ1b)
Control ratios at
Author, Measure Measure at Measure at final time
year Outcomes Intervention n at BL time point 2 time point points Significance
Asthma
Jan , Monitoring adherence Control 71 85.6 NA 12 week, 93.5 NA
1
2007 (peak flow meter Education and 82 83.5 12 week, 99.7
technique score (%)) interactive asthma
monitoring system
Monitoring adherence Control 71 Mean, 21 12 weeks, Significantly
(asthma diary entries SD, 4.5 mean, 15 different from
per month) SD, 5.3 BL value
Education and 82 Mean, 27 12 weeks,
interactive asthma SD, 3.2 mean, 23
monitoring system SD, 4.3
Monitoring adherence Control 71 93.2 12 weeks, 53.4
(adherence to asthma Education and 82 96.0 12 weeks, 82.5
diary (%)) interactive asthma
monitoring system
Therapeutic adherence Control 71 80.3 12 week, 93.1
(DPI or MDI plus Education and 82 82.1 12 week, 96.5
spacer technique interactive asthma
score (%)) monitoring system
Therapeutic adherence Control 71 82.3 12 week, 42.1
(adherence to inhaled Education and 82 83.5 12 week, 63.2
corticosteroid, (%)) interactive asthma
monitoring system
Joseph , Controller medication Control 143 NR NA 12 months, n(%) NA 0.09
2
2007 adherence: 18 (12.6)
positive behavior Puff City internet 152 12 months, n(%)
change intervention 31 (20.4)
Controller medication Control 143 12 months, n(%) 0.09
adherence: 91 (63.6)
no change in negative Puff City internet 152 12 months, n(%)
behavior intervention 95 (62.5)
Controller medication Control 143 12 months, n(%) 0.09
adherence: negative 34 (23.8)
change in behavior Puff City internet 152 12 months, n(%)
intervention 26 (17.1)
Rescue inhaler Control 143 12 months, n(%) 0.01
availability: positive 46 (32.2)
behavior change Puff City internet 152 12 months, n(%)
intervention 59 (38.8)
Rescue inhaler Control 143 12 months, n (%) 0.01
availability: 62 (43.3)
G-227
Evidence Table 28. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes of asthma and COPD (KQ1b) (continued)
Control ratios at
no change in negative Puff City internet 152 12 months, n (%)
Rescue inhaler Control 143 12 months, n (%) 0.01
availability: 35 (24.5)
negative change in Puff City internet 152 12 months, n (%)
Krishna, Asthma Knowledge Control 23 Mean, 48.41 NA 12 months NA <0.01
3
2003 score (caregivers of SD, 6.64 mean, 52.3
children 0-6yr) SD, 5.55
Interactive asthma 24 Mean, 47.94 12 months
education SD, 5.24 mean, 55.68
SD, 4.28
Asthma knowledge Control 28 Mean, 49.57 12 months <0.01
score (caregivers of SD, 4.75 mean, 55.38
children 7-17yr) SD, 4.16
SD, 4.28
Asthma knowledge Control 28 Mean, 43.44 12 months <0.001
score (children 7-17yr) SD, 4.75 mean, 47.51
SD, 5.95
SD, 5.56
Change in Control 23 mean, 2.52 0.0293
knowledge(caregivers SD, 6.71
of children 0-6yr) median, 5
95% CI, -0.38 to
5.42
Interactive asthma 24 mean, 7.97 <0.0001
education SD, 4.57
median, 7
95% CI, 5 to 11
Change in knowledge Control 28 mean, 2.38 0.0079
(caregivers of children SD, 4.38
7-17yr) median, 2.55
95% CI, 0 to 4
Interactive asthma 26 mean, 4.62 <0.0001
education SD, 4.48
median, 3
95% CI, 2 to 7
G-228
Evidence Table 28. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes of asthma and COPD (KQ1b) (continued)
Control ratios at
Change in knowledge Control 27 mean, 4.44 0.0001
(children 7-17yr) SD, 5.49
median, 4
95% CI, 2 to 7
Interactive asthma 25 mean, 10 <0.0001
education SD, 6.99
median, 8
95% CI, 7 to 11
COPD
Nguyen, Dyspnea knowledge Face-to-face dyspnea 20 Mean, 12.5 3 months 6 months NA Group P:
20084 score (range 0-15) self-management SD, 2.3 mean,13.3 mean,13.8 0.49
program SD, 1.6 SD, 1.5 time P value:
Internet-based 19 Mean, 12.6 3 months 6 months <0.001
dyspnea self- SD, 1.8 mean, 13.8 mean, 14.1 group X time
management SD,1.0 SD, 1.0 P value: 0.68
program
Self-efficacy score for Face-to-face dyspnea 20 Mean, 4.6 3 months 6 months Group P: 0.18
managing dyspnea self-management SD, 2.4 mean, 5.5 mean, 5.0 time P value:
(range 0-10) program SD,3.3 SD, 3.6 0.2
Internet-based 19 Mean, 4.7 3 months 6 months group X time
dyspnea self- SD, 2.3 mean, 6.8 mean, 6.7 P value: 0.34
management SD,2.3 SD, 2.6
program
NS = not specified, NA = not applicable, yr = year, SD = standard deviation, BL = baseline, NR = not reported
Reference List
Crit Care Med 2007; 175(9):888-95.
G-229
Evidence table 29. Description of RCTs addressing the impact of CHI applications on intermediate outcomes on miscellaneous topic
Year data
CVD
Kukafka, Individuals Interactive NS NS Unspecified AMI risk Tailored Web- -1
20021 interested consumer criteria based,
health care Non-tailored
Web-based
Non-tailored
paper based.
Simkins, Individuals Electronic Primary Duration, 64-67yr Group1 Group 2, 3
19862 interested medication care or 3 months Group 3
in their own reminder specialty
health care clinics at an
university
health care
Arthritis
Lorig, Individuals Interactive NS 2004/NS 18 and older, Active treatment Usual care Online 1
20083 interested consumer a diagnosis of OA, for cancer for 1 intervention
in their own website rheumatoid arthritis year,
health care (RA), participated in the
or fibromyalgia, small-group
could have other ASMP or the
chronic conditions Chronic Disease
Internet and email Self-Management
access Program
agreed to 1–2 hours
per week of log-on
time spread over at
least 3
sessions/week for 6
weeks
Back pain
Buhrman, Individuals Interactive Home/ NS 18-65 years old, Suffer of pain that Wait-list Internet-based 2
4
2004 interested consumer residence Internet access, can increase as a pain
in their own website been in contact with consequence of management
health care a physician, activity, program
have back pain, wheelchair bound,
have chronic pain have planned any
(>3 months) surgical treatment,
suffer from heart
G-230
Evidence table 29. Description of RCTs addressing the impact of CHI applications on intermediate outcomes on miscellaneous topic (continued)
Year data
and vascular
disease
Behavioral risk factors
Oenema, Individuals Personalize NS 2004/ NS 30 years or older, Insufficient Control Internet group 3
20085 interested d health risk Dutch adults, understanding of group
in their own assessment Internet skills, the Dutch
health care tool sufficient language,
understanding of the poor Internet skills
Dutch language
Breast cervical prostate and laryngeal cancer
Jones, Individuals Interactive Clinician 1996/ NS Breast, laryngeal, Receiving Booklet Personalized 1
19996 interested consumer office prostate, cervical palliative information computer
in their own website cancer patients treatment, information
health care receiving care at no knowledge of General
oncology center, diagnosis, computer
visual or mental information
handicap,
severe pain
Cervical cancer
Campbell, Individuals Personalize Clinician 1995/ NS Between 18 and 70 Survey Survey with -1
19977 interested d health risk office years, without computer
in their own assessment can speak and read computer generated
health care tool English well enough generated printed feed
to use computer printed feed back
back
Cancer, Prostate
Forsch, Individuals Interactive Home/ 2005 >50 yr, Control Traditional 2
8
2008 interested consumer residence Men decision aid
health care Chronic disease
trajectory model
combined
Caregiver decision making
Brennan, Caregivers Interactive Home/ NS Primary Comparison Computer link 2
9
1995 of persons consumer residence responsibility as a group program
with website family caregiver for a
Alzheimer's person with
Disease Alzheimer's disease
living at home,
has a local
G-231
Year data
telephone exchange,
the ability to read
and write English
Change in health behavior
Harari, Individuals Personalize NS 2001/ NS 65 and older Nursing home Usual care HRA-O 1
10
2008 interested d health risk resident, control intervention
in their own assessment needing help in group group
health care tool basic activities of
daily living,
dementia,
terminal disease,
non-English
speaking
Paperny, Adolescent Personalize Clinician Duration 3 Voluntary Participants Group Q: Group (1): 265
11
1990 with high d health risk office years participation, both unwillingness 251 participants
risk assessment male and female, participants those who was
behavior tool Teen agers those who given computer
has given a questionnaire
written after the
questionnair physical exam
e before and printout
physical remain private
exam and
printout Group (2): 294
shared with participants
the clinician those who was
given computer
questionnaire
before the
physical exam
and printout
shared with
clinician
Headache
Devineni, Individuals Personal Home/ Chronic tension or New headache Delayed Treatment 2
200512 interested monitoring residence migraine HA for at onset within the
in their own device least one year past year,
health care head injury or
major illness in
temporal proximity
G-232
Year data
to headache
onset,
Secondary
headache
diagnosis,
Concurrent
chronic pain
disorder other
than primary
migraine or
tension headache
HIV/AIDS
Flatley- Individuals Interactive Home/ NS HIV infected, Received Received
Brennan, interested consumer residence ability to read and brochure computer
199813 in their own website type English, intervention
health care home telephone line
Menopause HRT
Rostom, Individuals Computeriz Home/ NS 40-70, Audio Interactive 0
14
2002 interested ed decision residence women, booklet computerized
in their own aid pre and post DA
health care menopausal,
fully fluent in spoken
and written English,
no evidence of
cognitive impairment
or psychiatric illness
Schapira, Individuals Personalize Clinician May 2002- 45-74 yr, Non English Printed Computer- 2
15
2007 interested d health risk office Oct 2003 female, speaking, pamphlet based decision
in their own assessment post menopausal, MMSE < 23 aid
health care tool VA clinic patient
Preventing falls in the elderly
Yardley, Individuals Interactive NS July-Dec <65 yr, 5
16
2007 interested consumer 2005 used site more
in their own website, than once
health care
Use of contraception
Chewning, Individuals Computer Clinician NS < 20 years, Standard Computer 0
19917 interested based office Female, information based
in their own decision Aid ability to read and interactive
G-233
Year data
health care understand English, decision aid
expressed interest in
getting a
contraceptive
NS = Not specified, OA = Osteoarthritis, RA = rheumatoid arthritis, CHESS = Comprehensive Health Enhancement Support System, Yr = year
Reference List
1 Kukafka R, Lussier YA, Eng P, Patel VL, Cimino JJ. Web-based tailoring and its effect on self-efficacy: results from the MI-HEART randomized controlled
trial. Proc AMIA Symp 2002; 410-4.
2 Simkins CV, Wenzloff NJ. Evaluation of a computerized reminder system in the enhancement of patient medication refill compliance. Drug Intell Clin
Pharm 1986; 20(10):799-802.
3 Lorig KR, Ritter PL, Laurent DD, Plant K. The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or
fibromyalgia. Arthritis Rheum 2008; 59(7):1009-17.
4 Buhrman M, Faltenhag S, Strom L, Andersson G. Controlled trial of Internet-based treatment with telephone support for chronic back pain. Pain 2004;
111(3):368-77.
5 Oenema A, Brug J, Dijkstra A, de Weerdt I, de Vries H. Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated
fat intake, physical activity and smoking cessation: a randomized controlled trial. Ann Behav Med 2008; 35(2):125-35.
6 Jones R, Pearson J, McGregor S et al. Randomised trial of personalised computer based information for cancer patients. BMJ 1999; 319(7219):1241-7.
7 Campbell E, Peterkin D, Abbott R, Rogers J. Encouraging underscreened women to have cervical cancer screening: the effectiveness of a computer strategy.
Prev Med 1997; 26(6):801-7.
8 Frosch DL, Bhatnagar V, Tally S, Hamori CJ, Kaplan RM. Internet patient decision support: a randomized controlled trial comparing alternative approaches
for men considering prostate cancer screening. Arch Intern Med 2008; 168(4):363-9.
9 Brennan PF, Moore SM, Smyth KA. The effects of a special computer network on caregivers of persons with Alzheimer's disease. Nurs Res 1995;
44(3):166-72.
10 Harari D, Iliffe S, Kharicha K et al. Promotion of health in older people: a randomised controlled trial of health risk appraisal in British general practice. Age
Ageing 2008; 37(5):565-71.
G-234
11 Paperny DM, Aono JY, Lehman RM, Hammar SL, Risser J. Computer-assisted detection and intervention in adolescent high-risk health behaviors. 1990;
116(3):456-62.
12 Devineni T, Blanchard EB. A randomized controlled trial of an internet-based treatment for chronic headache. Behav Res Ther 2005; 43(3):277-92.
13 Flatley-Brennan P. Computer network home care demonstration: a randomized trial in persons living with AIDS. Comput Biol Med 1998; 28(5):489-508.
14 Rostom A, O'Connor A, Tugwell P, Wells G. A randomized trial of a computerized versus an audio-booklet decision aid for women considering post-
menopausal hormone replacement therapy. Patient Educ Couns 2002; 46(1):67-74.
15 Schapira MM, Gilligan MA, McAuliffe T, Garmon G, Carnes M, Nattinger AB. Decision-making at menopause: a randomized controlled trial of a
computer-based hormone therapy decision-aid. Patient Educ Couns 2007; 67(1-2):100-7.
16 Yardley L, Nyman SR. Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation. Health
Promot Int 2007; 22(2):122-8.
38(3):227-39.
G-235
Evidence Table 3. Description of consumer characteristics in RCTs addressing the impact of CHI applications on health care processes (KQ1a)
Author, Control Gender,

Year Intervention Age Race, n(%) Income Education, n(%) SES n(%) Other characteristics
Asthma
Bartholomew, Control n=63 Range, Hispanic,28(44.1) NS Parent education: NS Male, Insurance (private)
1
2000 usual care 6-17 African None, 2(3.2) 44(69.8) ,5(8.5)
American,32(50.8) Elementary, 15(23.8) Female, Medicare, 5(8.5)
White ,3(4.8) High school, 28(44.4) 19(30.2) Medicate, 27(45.8)
Other, College, 18(27.0) Self pay, 3(5.1)
None, 19(32.2)
Asthma:
Mild, 13(24.6)
Moderate, 25(47.2)
Severe, 15(28.3)
Parent’s marital status:
Single, 15(23.8)
Married, 39(61.9)
Widowed, 2(3.2)
Divorced, 3(4.8)
Separated, 4(6.3)
Parent in home:
One, 24(38.1)
Two, 39(61.9)
Parents employment :
Fulltime
, 30(48.4)
Part-time, 8(12.9)
Not, 24(38.7)
Parents education:
None,2(3.2)
15(23.8)
High school, 28(44.4)
College, 18(27.0)
Intervention n,70 Range,6 Hispanic,33(47.1) NS None,3(4.3) NS Male, Insurance (private),
computer -17 African Elementary, 20(29.0) 42(60.0) 3(5.1)
intervention American,34(48.6) High school, 34(49.3) Female, Medicare, 3(5.1)
(watch, discover, White ,2(2.9) College, 12(17.3) 28(40.0) Medicate, 30(50.8)
think and act) Other,1(1.4) Self pay, 5(8.5)
None, 18(30.5)
Asthma:
G-17
Evidence Table 3. Description of consumer characteristics in RCTs addressing the impact of CHI applications on health care processes (KQ1a) (continued)
Mild, 22(40.8)
Moderate, 14(25.9)
Severe, 18(33.3)
Parent’s marital status:

Single, 15(21.7)
Married, 39(56.5)
Widowed, 1(1.4)
Divorced, 4(5.8)
Separated, 10(14.5)
Parent in home:
One, 30(44.1)
Two, 38(55.9)
Parents employment :
Fulltime
, 18(27.3)
Part-time, 12(18.2)
Not, 36(54.5)
Parents education:
None, 3(4.3)
Elementary, 20(29.0)
High school, 34(49.3)
College, 12(17.3)
Guendelman, Control, 68 12.2 Black, 50 (74) NS NS NS Male, 37 (54 Public health
20022 participants (2.9) White,8 (12) insurance,63(93)
used an asthma Others,10 (15) Private health
diary. insurance,4(6)
Parent is the care-giver
,55(81)
Primary caregiver
education - high
school,35(51)
College,33(49)
Passive smoking in the
household,36(53)
Mild asthma,20(29)
Moderate
asthma,40(59)
Severe asthma ,8(12)
Daily puffs of quick-
relief
medication,15(0.7)
G-18
ER visit,2.40(2.33)
Nights in the
hospital,0.66(1.23)
Intervention,66 12.0 (2.3 Black, 52 (79) NS NS NS Male, 40 Public health

Health Buddy(is a White,5 (8) (61) insurance,61(92)
personal and Others,9 (14) Private health
interactive insurance,5(8)
communication Parent is the care-giver
device) ,47(71)
Primary caregiver
education high
school,26(39)
College,40(61)
Passive smoking in the
household,35(53)
Mild asthma,15(23)
Moderate
asthma,43(66)
Severe asthma ,7(11)
Daily puffs of quick-
relief
medication,1.6(0.7)
ER visit ,2.10(2.09)
Nights in the
hospital,0.56(1.04)
Jan, Verbal information Mean, NR NR Education of primary NR M, 28(36.8) History of asthma (yr),
3
2007 and booklet for 9.9 caregiver F, 48(63.2) mean, 2.1
asthma education SD, 3.2 HS diploma or below, SD, 1.2
with written 43(56.6) Asthma severity:
asthma diary College or above, mild,
33(43.4) 33(43.4)
moderate,
35(46.1)
severe,
8(10.5)
Intervention Mean, Education of primary M, 35(39.7) History of asthma (yr),
10.9 caregiver F, 53(60.2) mean, 2.4
SD, 2.5 HS diploma or below, SD, 1.9
58(66.0) Asthma severity:
College or above, mild,
30(34.0) 33(37.5)
G-19
moderate, 43(48.9)
severe,
12(13.6)
Krishna, Traditional care Range, White non-Hispanic, NR Preschool/none, NR M, 76(62.8)
20034 0-17 102(84.3) 58(47.9) F, 45(37.2)
Black non-Hispanic, Kindergarten, 6(5)
9(7.4) Elementary, 27(22.3)
AIAN, 7(5.8) Jr High, 24(19.8)
Not specified, 3 High School, 6(5)
Internet-enabled Range, White non-Hispanic, NR Preschool/none, NR M, 72(67.3)
interactive 0-17 93(86.9) 48(44.9) F, 35(32.7)
Multimedia Black non-Hispanic, Kindergarten,
asthma education 10(9.3) 12(11.2)
program AIAN, 2(1.9) Elementary, 23(21.5)
Not specified, 2(1.9) Jr High, 19(17.6)
High school, 5(4.1)
Chewning, Standard NR NR NR NR NR F(100) NR
5
1999 information
Computerized F(100)
decision aid
NR= Not Reported, SD= Standard Deviation, SES= Socioeconomic Status, Yr= year, CBT= Cognitive Behavioral Therapy, WL= Wait List, AIAN= American Indian/Alaska
Native, M = Male, F = Female
Reference List
1. Bartholomew LK, Gold RS, Parcel GS et al. Watch, Discover, Think, and Act: Evaluation of computer-assisted instruction to improve asthma self-
2. Guendelman S, Meade K, Benson M, Chen YQ, Samuels S. Improving asthma outcomes and self-management behaviors of inner-city children: A
5. Chewning B, Mosena P, Wilson D et al. Evaluation of a computerized contraceptive decision aid for adolescent patients. Patient Educ Couns 1999;
38(3):227-39.
G-20
Evidence Table 30. Description of consumer characteristics studies addressing the impact of CHI applications on intermediate outcomes in miscellaneous conditions
Control
Author, Education, Gender, Marital
year Interventions Age Race, n(%) Income n(%) SES n(%) Status, n(%) Other
CVD
Kukafka, Control NS NS NS NS NR NS
1
2002 tailored Web- NS NS NS NS NR NS
based
Non-tailored NS NS NS NS NR NS
Web-based
Simkins, Group1 Mean, 64 NS NS NS NR Chronic
19862 medication/patient:
mean, 2.95
Group 2 Mean, 66 NS NS NS NR Chronic medication/

patient:
mean, 3.09
Group 3 Mean, 67 NS NS NS NR Chronic

medication/patient:
mean, 2.78
Arthritis
Lorig, Usual care Mean, White non- NS Mean, 15.7 NR F, Married: Health-related Web site
3
2008 52.5 Hispanic, SD, 3.11 425(90.5) 425(71.1) visits last 6 months:
range, 425(93.7) mean, 2.85
22–89 SD, 11.68
SD, 12.2
Online Mean, White non- NS Mean, 15.6 NR F, Married: Health-related Web site
intervention 52.2 Hispanic, SD, 3.09 441(89.8) 441(65.5) visits last 6 months:
SD, 10.9 441(90.9) mean, 2.87
SD, 11.2
Back pain
Buhrman, Wait-list Mean, 45 NS NS <8 yr, 7(24.1) NR M, Sick leave:
4
2004 SD, 10.7 8-12 yr, 6(21) 11 (37.9) Yes:12 (41.4)
12-14 yr, F, No:17 (58.6)
2 (6.9) 18 (62.1) Pain location:
14-16 yr, Back, 12 (41.4)
14 (48.3) Back plus other
area,17(58.6)
Previous treatment:
PT:11(37.9)
Chiropractor:12 (41.4)
Naprapathy:3 (10.3)
Psychologist:6 (20.7)
G-236
(continued)
Control
Pain Clinic:2 (6.9)
Internet-based Mean, NS NS <8 yr, 2 (9.1) NR M, Sick leave:
pain 43.5 8-12 yr, 6 (27) 8 (36.4) Yes:
management SD, 10.3 12-14 yr, F, 5 (22.7)
program 3 (13.6) 14 (63.6) No:
14-16 yr, 17 (77.3)
11 (50) Pain location:
Back,
7 (31.8)
Back plus other area,
15 (68.2)
Previous treatment:
PT:
10 (45.5)
Chiropractor:
8 (36.4)
Nephropathy:
4 (18.2)
Psychologist:
3 (13.6)
Pain Clinic:
1 (4.5)
Oenema, Control group Mean, NS NS Educational NR M,
20085 44.1 level: 507 (47)
SD, 10.4 High 453 (42) F,
Medium 324 572 (53)
(30)
Low 302 (28)
Internet group Mean, NS NS Educational NR M,
43.1 level: 497 (46)
SD, 10.4 High 432 (40) F,
Medium 3 583 (54)
67 (34)
Low 281 (26)
Jones, Booklet
6
1999 information NS NS NS NS NS NS NS NS
NS NS NS NS NS NS NS NS
Cervical cancer
G-237
(continued)
Control
Campbell, Survey < 50 yr, Australian NS 8-12 yr,(55) NR Married or Full/part time work, (44)
19977 without (78) born, (94) living with NS
computer partner, (71)
generated
printed feed
back
intervention NS NS NS NS NR NS
Cancer, Prostate
Forsch, Control Mean, 59 White non- NS High school or NR NS Married Internet access, n, (%):
20088 SD, 5.1 Hispanic, less 6(4) 123(81.5) home 127(84.1)
133(880) Some Other work 24(15.9)
Black non- college44(29.1) 28(18.5)
Hispanic , College
4(2.6) 42(27.8)
Latino/Hispa Some graduate
nic, 6(4) school 10(6.6)
API, 6(4)
Not
specified,
2 (1.3)
Traditional Mean, White non- NS High school or NR NS Married Internet access, n. (%):
decision aid 58.5 Hispanic, less 8(5.2) 119(76.8) home 136(87.7)
SD, 5.5 133(85.8) Some college Other work 19(12.3)
Black non- 39(25.2) 36(23.2)
Hispanic, College44(28.4)
6(3.9) Some graduate
Latino/ school13(8.4)
Hispanic,
7(4.5)
API, 4(2.6)
Not
specified,
5 (3.2),
Chronic Mean, White non- NS High school or NR NS Married Internet access, n, (%):
disease 58.4 Hispanic, less 6(3.9) 114(74.5) home 130(85)
trajectory median, 127(83) Some Other work 12(15)
model range, Black non- college40(26.1) 39(25.5)
SD, 5.6 Hispanic, College
2(1.3) 35(22.9)
Latino/ Some graduate
G-238
(continued)
Control
Hispanic, school 12(7.8)
15(9.8)
API, 7(4.6)
Brennan, Comparison Mean, 64 White non- NS 12-16 yr, (86) NR F,(67)
9
1995 group Hispanic,
(72)
Experimental NS NS NS NS NR NS
Change in Health behavior
Harari, Usual care Mean, NS NS NS NR F, Fair or poor general-
10
2008 control group 74.2 564(52.9) health perception: 271
SD, 6 (25.4)
Ischemic heart disease:
175 (16.4)
diabetes:73(6.9
HRA-O Mean, NS NS NS NR F, Fair or poor general-
intervention 74.7 526(56.0) health perception: 207
group SD, 6.3 (22.0)
Ischemic heart disease:
170 (18.1)
diabetes: 70(7.5)
Paperny, Control: mean,15.1 White,(33) Financial NR NR M, NS
199011 Group Q: 251 SD, 1.46 Hawaiian, assistance 131(52)
participants (12) (10)
those who has Oriental,
given a written (32)
questionnaire Pacific/mixtu
before re, (12)
physical exam Other (11)
and printout
shared with
the clinician
Intervention mean,14.9 White (33) (10) NR M,
Group (1): SD, 1.44 Hawaiian 154(58)
265 (13)
participants Oriental (30)
those who Pacific/mixtu
was given re (13)
computer Other (11)
G-239
(continued)
Control
questionnaire
after the
physical exam
and printout
remain private
Group (2): 294 mean, White (34) (11) NR NR M, 176 NS

participants 15.0 Hawaiian (60)
those who SD, 1.37 (14) Oriental
was given (32)
computer Pacific/mixtu
questionnaire re, (11)
before the Other, (9)
physical exam
and printout
shared with
clinician
Headache
Devineni, Delayed Mean, NS NS NS NR M,10 (21) Headache Index score:
200512 43.6 F, 37 (79) Mean, 35.5
SD, 11.8 SD, 15.5
Medication Index:
Mean, 0.85
SD 1.04
Yr computing:
Mean, 5.8
SD, 3.6
Treatment Mean, NS NS NS NR M,5 (12) HA Index:
43.6 F,34 (88) Mean 31.8
SD, 12 SD 17
Medication Index:
Mean 0.93
SD 0.99
Yrs computing:
Mean: 3.8
SD 2.4
HIV/AIDS
Flatley- Received Mean, 34 White non- NS Mean, 14 NR Living Alone:
Brennan, brochure SD, 10.8 Hispanic, SD, 2.7 mean, 27
13
1998 (58)
G-240
(continued)
Control
Received Mean, 33 White non- NS Mean, 13 NR Living Alone:

computer SD, 7.3 Hispanic, SD, 2.6 mean, 29
intervention (64)
Gustafson, Control NR NR NR NR NR NR HIV-infected people

199414 CHESS NR NR NR NR NR NR HIV-infected people
Menopause HRT
Rostom, Audio booklet Mean, NS NS 8-12 yr,7 (26.9) NR Currently not using HRT:
200215 53.8 12-16y r, 13, (50.0)
SD, 8.13 19(73.1 ) Menses:
7, (26.9)
Contemplating the
decision:
6, 2(3.1)
Strongly leaning:
18, (69.2)
Interactive Mean, NS NS 8-12yr, 6 (24) NR Currently not using HRT:
computerized 50.6 12-16 yr, 19 (76.0)
DA SD, 7.67 19 (76 )
Menses:
16 (64)
Contemplating the
decision:
8, (32)
Strongly leaning: 16
(64.0)
Schapira, Printed Mean, White non- USD NS NR NS

16
2007 pamphlet 57.8 Hispanic, 64 <19,999,
SD, 7.5 (73) 25 (28)
Black non- 20,000-
Hispanic, 34,999,
22(25) 32 (36)
AIAN,2 (2) 35,000-
49999,
17 (19)
50,000-
74,999,
G-241
(continued)
Control
11 (13)
75,000+,
3 (3)
Computer- Mean, White non- USD NS NR NS
based 57.8 Hispanic, 64 <19,999,
decision aid SD, 7.2 (72) 31 (35)
Black non- 20,000-
Hispanic, 24 34,999,
(27) 22 (25)
AIAN, 1(1) 35,000-
49999,
19 (21)
50,000-
74,999,
11 (12)
75,000+,
6 (7)
Preventing falls in the elderly
Yardley, Control NS NS NS NS NR M, 42 (31) Self-rated balance:
17
2007 F, 94 (69) good 13 (9.5)
quite good 32 (23.5)
have some problems 91
(67)
health condition (co
morbidity):
unsteadiness 97(71)
poor vision 34 (25)
take >=4 meds 60 (44)
take <4 meds38 (28)
Tailored NS NS NS NS NR M, 54 (37) Self-rated balance:
F, 90 (63) good ,11 (8)
quite good 38 (26)
have some problems 95
(66)
health condition
(co morbidity):
unsteadiness 106(74)
poor vision 43(30)
take >=4 meds 51 (35)
take <4 meds52 (36)
G-242
(continued)
Control
Chewning, Standard NS NS NS NS NR NS
19918 information
Computerized NS NS NS NS NR NS
decision
NR= Not Reported, NS= Not Significant SD= Standard Deviation, SES= Socioeconomic Status, Yr= year, API = Asian, Pacific Islander,
AIAN = American Indian / Alaska Native, CVD = Cardiovascular Disease, F = female, M = Male
Reference List
Pharm 1986; 20(10):799-802.
111(3):368-77.
Prev Med 1997; 26(6):801-7.
44(3):166-72.
G-243
(continued)
Ageing 2008; 37(5):565-71.
116(3):456-62.
14 Gustafson DH, Hawkins RP, Boberg EW, Bricker E, Pingree S, Chan CL. The use and impact of a computer-based support system for people living with
AIDS and HIV infection. 1994; 604-8.
Promot Int 2007; 22(2):122-8.
38(3):227-39.
G-244
Evidence Table 31. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in miscellaneous conditions of interest
Author, Outcomes Control n Measure Measure at Measure at Measure Measure at Ratios at Significance
year at BL time point time point at time final time time
Intervention 2 3 point 4 point points
CVD
Kukafka, Symptoms Control 17 Self-efficacy BL,
1
2002 scores time point 2,
<.05
Final time
point,
Non-Tailored 13 Self-efficacy
scores
Tailored 17 Self-efficacy BL,
scores time point 3,
<.001
Action Control 32 Self-efficacy 1 month 3 month BL,

<.05
final time point,

Non-tailored 31 self-efficacy 1 month 3 month
scores
Tailored 31 self-efficacy 1 month 3 month BL,
<.05
time point 3,
<.05
Cognitive Control Self-efficacy 1 month 3 month
scores
Non-Tailored Self-efficacy 1 month 3 month
scores
Tailored Self-efficacy 1 month 3 month BL,
<.05
time point 3,
<.001
time point 4,
final time point,
Simkins, Medication Control 104 Compliant Month 3:
19862 refill months mean, 0.58
compliance SD, 0.5
Group 2 101 Compliant Month 3:
received months mean, 0.65
G‐245

Evidence Table 31. Outcomes in studies addressing the impact of CHI applications on intermediate outcomes in miscellaneous conditions of interest (continued)
reminder by SD, 0.52
postcard
Group 3 69 Compliant Month 3
calling
Medication Control 104 non-compliant Month 1 Month 3
refill non- months mean, 0.43
compliance SD, 0.5
Group 2 101 Non-compliant Month 1 Month 3
postcard
Group 3 69 Non-compliant Month 1 Month 3
calling
Arthritis
Lorig, Health Control 344 Mean, 2.37 6months 1year:
3
2008 distress SD, 1.19 mean, 2.25
SD, 1.19
Online 307 Mean, 2.41 6months 1year:
intervention SD, 1.2 mean, 2
SD, 1.18
Activity Control 344 Mean, 3.22 6months 1year
limitation SD, 0.903 mean, 3.29
SD, 0.885
Online 307 Mean, 3.17 6months 1year
SD, 0.962
Self reported Control 344 Mean, 0.569 6months 1year
global health SD, 0.446 mean, 0.573
SD, 0.457
Online 307 Mean, 0.547 6months 1year
SD, 0.445
Pain Control 344 Mean, 6.37 6months 1year
SD, 2.22 mean, 6.1
SD, 2.35
Online 307 6months 1year
G‐246

SD, 2.53
Self efficacy Control 344 Mean, 4.96 6months 1year:
SD, 1.98 mean, 5.34
SD, 2.06
Online 307 Mean, 5.08 6months 1year:
SD, 2.09
Back pain
Buhrman, CSQ- Control 29 Mean, 12.3 2 months:
20044 Diverting SD, 7.4 mean, 11.9
attention SD, 6.9
Cognitive 22 Mean, 11.6 2 months:
behavior SD, 5.7 mean, 12.3
CSQ- Control 29 Mean, 5.4 2 months
Reinterpret SD, 6.5 mean, 4.6
pain SD, 5.9
sensations Cognitive 22 Mean, 3.6 2 months
CSQ-Coping Control Mean, 18.3 2 months
self-statement SD, 6.6 mean, 17.3
SD, 6.7
Cognitive Mean, 18.4 2 months
CSQ-Ignore Control 29 Mean, 13.5 2 months
pain SD, 6.6 mean, 12.9
sensations SD, 6.5
Cognitive 22 2 months
behavior mean, 13.7
intervention SD, 7
CSQ-Praying Control 29 Mean, 10.4 2 months:
or hoping SD, 6.7 mean, 8.5
SD, 6
Cognitive 22 Mean, 12 2 months:
G‐247

Catastrophizi SD, 6.9 mean, 12.3
ng SD, 7.2
Cognitive 22 Mean, 13.6 2 months
Increase SD, 6.1 mean, 16.9
activity level SD, 6.3
Cognitive 22 Mean, 14.4 2 months
behavior SD, 5 mean, 14.8
CSQ-Control Control 29 Mean, 2.9 2 months:
over pain SD, 1.1 mean, 2.9
SD, 1
Cognitive 22 Mean, 2.8 2 months:
behavior SD, 1 mean, 3.9
Oenema, Self-rated Control 930 Mean, -0.16 one month:
20085 saturated fat SD, 0.82 mean, -0.19
intake SD, 0.82
Internet group 887 Mean, -0.19 One month:
SD, 0.78 mean, -0.18
SD, 0.79
Self rated PA Control 890 Mean, -0.29 One month
level SD, 0.92 mean, -0.3
SD, 0.93
Internet group 827 Mean, -0.31 One month
SD, 0.91 mean, -0.29
SD, 0.85
Jones, Satisfaction Booklet 150 58(40)
19996 Score >2 (n (control)
(%)) Personal 156 68(46)
computer
information
Satisfaction Booklet 150 32 to 48
Score (control)
G‐248

>2(95% CI of Personal 156 38 to 54
percentage computer
information
Prefer Booklet 150 12/122(10)
computer to (control)
10 minute Personal 156 38/131(29)
consultation computer
with information
professional
Cervical cancer
Campbell, Pap smear Control 32 6 months
7
1997 within 6 (24.6), 95%
months in CI
women who Experimental 56 6 months NS
were under (37.8), 95%
screened by CI
Path report
18-49 years
Pap smear Control 44 6 months

within 6 Intervention 52 6 months NS
months in
women who
were under
screened by
Self report
18-49 years
within 6 Intervention 38 6 months NS (0.09)
months in
women who
were under
screened by
Path report
50-70 years

within 6 Intervention 22 6 months 0.026
G‐249

months in
women who
were under
screened by
Self report
50-70 years
Cancer, Prostate
Forsch, Total Traditional 155 Posttest:
8
2008 knowledge decision aid mean, 8.65
scores(compl SD, 0.18
eter cases Chronic 153 Posttest:
only), mean disease mean, 8.03
(SE) trajectory SD, 0.18
model
Combined 152 Posttest:
mean, 8.03
SD, 0.18
Brennan, Decision Control 49 Likert scale, 14 12 months:
9
1995 confidence items, 5 mean, 54.7
choices SD, 6.1
mean, 54.65
SD, 7.3
Experimental 47 Likert scale 14 12 months: <.01
items, 5 mean, 56.8
choices SD, 7
mean, 51.9
SD, 6
Improved Control 49 Number of 12 months
decision alternatives mean, 2.37
making skill caregiver SD, 78
considers to
solve a
problem:
mean, 2.51
SD, 0.91
Experimental 47 Number of 12 months 0.2
alternatives mean, 2.4
G‐250

caregiver SD, 0.61
considers to
solve a
problem:
mean, 2.53
SD, 0.78
Isolation Control 49 Score on 12 months
Instrumental mean, 62.6
and SD, 16
Expressive
Support Scale
(IESS)
mean, 62.7
SD, 15.5
Experimental 47 Mean, 63.4 12 months 0.51
SD, 16.6 mean, 65
SD, 17.4
Change in health behavior
Harari, Self-reported Control 1066 12
10
2008 health months:(84)
behavior HRA-O 940 12 months
intervention (76)
group
Preventative Control 1066 12 months
care uptake (84)
HRA-O 940 12 months

intervention (76)
group
Paperny, High cigarette Control 10
199011 use
Intervention 25 P=<0.01
group 1
group 2
G‐251

Frequent Control 8
marijuana use
(weekly) Intervention 19 P=<0.04
group 1
group 2
High alcohol Control 13

use (weekly)
group 1
Intervention 28 NS
group 2
Problems at Control 24
home with
parents Intervention 70 P=<0.001
,family group 1
Intervention 72 P=<0,001
group 2
Often sad, Control 34

upset or
unhappy Intervention 69 P=<0.001
group 1
Intervention 66 P=<0,007
group 2
G‐252

Feeling sad Control 45
or down lately
group 1
Intervention 63 NS
group 2
Would like Control 27

contraceptive
information Intervention 74 P=<0.001
group 1
group 2
Has a lover Control 56

now
group 1
Intervention 82 NS
group 2
Had sexual Control 56

intercourse
Intervention 75 NS
group 1
Intervention 75 NS
group 2
G‐253

Taking Control 50
medications
Intervention 61 NS
group 1
Intervention 62 NS
group 2
Headache
Devineni, Headache Control 47 Mean, 35.5 2 months
200512 symptom SD, 20.9 mean, 31.7
questionnaire SD, 22.4
SD, 19.3 mean, 20.3
SD, 15.9
Headache Control 39 Mean, 54.2 2 months
disability SD, 20.5 mean, 49.6
inventory SD, 23.1
SD, 18.8 mean, 38
SD, 19.5
CES-D 47 Mean, 13.9 2 months
(depression SD, 9.5 mean, 14.3
scale) SD, 12.1
Trait-anxiety Control 39 2 months
scale Mean, 25.6 mean, 20.8
SD, 15.9 SD, 17.2
Intervention 39 2 months
mean, 18.4
SD, 15.7
HIV/AIDS
Flatley- Improved Control 26 Mean score Post- BL, 0.05
Brennan, decision mean, 52.8 intervention: time point 2,
199813 making SD, 6 mean, 56.47 final time point,
confidence SD, 4.2 0.05
Computer link 31 Mean score Post- BL, 0.05
mean, 54.35 intervention: time point 2,
SD, 5.9 mean, 51.45 final time point,
SD, 6.9 0.05
G‐254

Improved Control 26 Mean score: Post- BL, 0.05
decision mean, 4.73 intervention time point 2,
making skill SD, 1.4 mean, 5.47 final time point,
SD, 1.3 0.05
Computer link 31 Mean Score: Post- BL, 0.05
mean, 4.58 intervention time point 2,
SD, 1.5 0.05
Reduced Control 26 Mean score Post- BL, 0.05
social mean, 67.05 intervention time point 2,
isolation SD, 17 mean, 68 final time point,
SD, 16.8 0.05
Computer Link 31 Mean score Post- BL, 0.05
SD, 13.68 0.05
Differential Control 26 Mean score Post- BL, 0.05
decline in mean, 13.8 intervention final time point,
health status SD, 4.93 mean, 13.65 0.05
SD, 1.3
Computer link 31 Post- RR or BL, 0.05
intervention OR time point 2,
mean, 13 time No
SD, 1.7 point 2, improvement
0.05 over control
Gustafson Average Control 28 (65)
14
, 1994 Quality of life
CHESS 30 (68)
(%)
Hospital cost Control 97 Cost went

up $457
($/person/Mo
nth) CHESS 107 Cost went
down $148
Menopause HRT
Rostom, Realistic Control 26 Final score: Difference in p=0.015,
expectations difference in posttest t=2.530, mean
G‐255

200215 Mean scores; score- deviation
baseline and baseline =0.25.
point 4 score: score: p=0.023,
mean score mean, 52.7 Mann-Whitney
mean, 37.2 SD, 37.5 U = 205, Z = -
SD, 25.5 2.282
Computerized 25 Final score: Difference in p=0.015,
decision aid difference in posttest t=2.530, mean
Mean scores; score- deviation
baseline and baseline =0.25.
point 4 score: score: p=0.023,
mean score mean, 52.7 Mann-Whitney
mean, 32 SD, 37.5 U = 205, Z = -
SD, 30.4 2.282
Knowledge Control 26 Final score: Post- Difference in p= 0.019, t =
difference in interventi posttest 2.423, mean
Mean scores; on score- deviation =
baseline and question baseline 0.0906.
point 4 score: naire score p=0.017,
mean score: mean, mean, 8.4 Mann-Whitney
mean, 78.7 87.1 SD, 13.3 U = 201, Z= -
SD, 16.7 SD, 11.8 2.397
Computerized 25 Final score: Post- Difference in p= 0.019, t =
decision aid difference in interventi posttest 2.423, mean
Mean scores; on score- deviation =
baseline and question baseline 0.0906.
point 4 score: naire score p=0.017,
mean score: mean, mean, 17.5 Mann-Whitney
mean, 76.4 93.8 SD, 13.4 U = 201, Z= -
SD, 14.9 SD, 9 2.397
Schapira, Menopause- Control 86 3 months
16
2007 related mean, 15.5 ;
knowledge median, ;
and health- range, 14.9,
risk 16.0;
expectations Computer- 85 3 months
based decision mean, 15.1 ;
aid median, ;
range, 14.5,
15.7;,
G‐256

Satisfaction Control 85 3 months 3 months
with decision prior mean, 4.37
decision median,
range, 4.26,
4.48
Computer- 85 3 months 3 months
based decision prior mean, 4.37
aid decision median,
range, 4.26,
4.47
Decisional Control 85 3 months 3 months
conflict prior mean, 1.78
decision median,
range, 1.67,
1.90
computer- 85 3 months 3 months
aid decision median,
range, 1.62,
1.85
Decisional Control 85 3 months 3 months
Decisional decision median,
uncertainty range, 1.75,
subscale 2.05
Computer- 85 3 months 3 months
aid decision range, 1.73,
2.03
Decisional Control 85 3 months 3 months:

conflict prior mean, 1.78 :
Factors of decision range, 1.66,
uncertainty 1.91:
subscale Computer- 85 3 months 3 months:
aid decision SD, 1.61,
1.86
Decisional 85 3 months 3 months
G‐257

Effective decision median,
decision- range, 1.58,
making 1.82
subscale SD,
Decision to Control 86 3 months - 3 months
use hormone prior
therapy decision
Decision to Computer- 85 3 months - 3 months 0.85
use hormone based decision prior
therapy aid decision
preventing falls in the elderly
Yardley, Intention to Control 136 6 point scale Adter
200717 carry out the reviewing
recommende the
d activities intervention
or control
web site:
mean, 4.65
SD, 0.79
Tailored 144 6 point scale Adter
reviewing
the
intervention
or control
web site:
mean, 4.86
SD, 0.61
Personal Control 136 Adter
relevance reviewing
the
intervention
or control
web site
mean, 4.6
SD, 0.77
Tailored 144 Adter
reviewing
the
intervention
or control
G‐258

web site
mean, 4.83
SD, 0.65
Interest Control 136 Adter
reviewing
the
intervention
or control
web site
mean, 5.08
SD, 0.64
Tailored 144 Adter
reviewing
the
intervention
or control
web site
mean, 5.03
SD, 0.61
Suitability of Control 136 Adter
the activities reviewing
the
intervention
or control
web site
mean, 4.8
SD, 0.79
Tailored 144 Adter BL,
reviewing time point 2, CI
the -0.055, 0.009
intervention NS
or control
web site
mean, 4.95
SD, 0.6
Self-efficacy Control 136 Adter
reviewing
the
intervention
or control
G‐259

web site:
mean, 4.35
SD, 0.95
Tailored 144 Adter
reviewing
the
intervention
or control
web site:
mean, 4.61
SD, 0.7
Outcome Control 136 Adter
expectancy reviewing
the
intervention
or control
web site
mean, 4.79
SD, 0.74
Tailored 144 Adter
reviewing
the
intervention
or control
web site
mean, 4.78
SD, 0.67
use of contraception
Chewning, OC Control NA Mean, 1.95 Initial visit 1 year: BL, 0.709
199918 knowledge SD, 1.13 mean, 2.29 mean, 3.05 time point 2, 0
Chicago SD, 1.03 SD, 1.24 final time point,
NS
Computerized NA Mean, 1.89 Initial visit 1 year: BL, 0.709
decision aid SD, 1.07 mean, 3.28 mean, 3.23 time point 2, 0
SD, 1.17 SD, 1.27 final time point,
NS
OC Control NA Mean, 2.48 Initial visit 1 year BL, 0.813
knowledge SD, 1.21 mean, 3.58 mean, 3.76 time point 2, 0
Madison SD, 1.06 SD, 1.02 final time point,
0.031
G‐260

Computerized NA Mean, 2.46 Initial visit 1 year BL, 0.813
decision aid SD, 1.3 mean, 4.49 mean, 3.95 time point 2, 0
0.031
OC efficacy Control NA Initial visit 1 year BL,
Chicago mean, mean, 6.38 time point 2, 0
11.26 SD, 13.45 final time point,
SD, 15.93 NS
Computerized NA Initial visit 1 year BL,
decision aid mean, 4.59 mean, 5.66 time point 2, 0
NS
OC efficacy Control NA Initial visit 1 year BL,
Madison mean, 4.8 mean, 4.83 time point 2, 0
SD, 5.58 SD, 9.15
Computerized NA Mean, 2.09 Initial visit 1 year BL, NS
decision aid SD, 2.2 mean, 4 time point 2,
SD, 8.26
BL = baseline, SD = standard deviation, CI = confidence interval, OC = oral contraceptive, CES-D = Center for Epidemiologic Studies Depression Scale
Reference List
Pharm 1986; 20(10):799-802.
111(3):368-77.
G‐261

Prev Med 1997; 26(6):801-7.
44(3):166-72.
Ageing 2008; 37(5):565-71.
116(3):456-62.
14 Gustafson DH, Hawkins RP, Boberg EW, Bricker E, Pingree S, Chan CL. The use and impact of a computer-based support system for people living with
AIDS and HIV infection. 1994; 604-8.
Promot Int 2007; 22(2):122-8.
G‐262

38(3):227-39.
G‐263

Evidence table 32. Description of RCTs addressing the impact of CHI applications on relationship-centered outcomes
Year data
Breast cancer
Green, 20051 Individuals Personalized Clinician Between ≥18 yr, Previously Counseling Counseling -1
interested health risk office May 2000 Female, underwent without with
in their own assessment and Read, write and genetic computer computer
health care tool September speak English, counseling, intervention intervention
2002 Scheduled a genetic Testing for
counseling appt to inherited breast
evaluate personal cancer
and/or family history susceptibility
of breast cancer,
Able to give
informed consent
Gustafson, Individuals Interactive Home/ Between <60 yr, Allocated Received 2
2
2008 interested consumer residence April 1995 Breast cancer standard CHESS
in their own website and May patients, intervention intervention
health care 1997 Within 6 months of
diagnosis,
Not homeless,
Not active illegal
drug users
Gustafson, Individuals Interactive Home/ Between <60 yr, Allocated Received 1
diagnosis,
Not homeless,
Not active illegal
drug users
Maslin, 19984 Individuals Interactive Clinician NS Non metastatic Advanced breast Standard care Interactive -1
interested computerize office breast cancer cancer, computerized
in their own d video Metastatic video system
health care system disease,
Sensory
impairment,
do not
understand
English
Brennan, Caregivers Interactive Home/ NS Primary Comparison Computer 2
5
1995 of persons consumer residence responsibility as a group link program
G-264
Evidence table 32. Description of RCTs addressing the impact of CHI applications on relationship-centered outcomes (continued)
Year data
with website family caregiver for a
Alzheimer's person with
Disease Alzheimer's disease
living at home,
Has a local
telephone exchange,
The ability to read
and write English
HIV/AIDS
Flatley- Individuals Interactive Home/ NS HIV infected, Received Received 0
Brennan, interested consumer residence Ability to read and brochure computer
19986 in their own website type English, intervention
health care Home telephone line
Arthritis
Sciamanna, Individuals Interactive Home/ NS Had knee joint Patient did not Completed Completed -1
20057 interested consumer residence symptoms for at report having questionnaire questionnaire
in their own website least the past three knee joint before after
health care months, symptoms for at intervention intervention
Saw a doctor for least the past
knee symptoms, three months,
Has the diagnosis of Patient did not
osteoarthritis report having
been seen by a
doctor for the
knee symptoms,
Does not have
the diagnosis of
osteoarthritis
Vaginal or c-section delivery
Montgomery, Individuals Decision Home/ 2004 (may) Pregnant, Limited ability to Usual care Information 3
20078 interested analysis tool residence to 2006 one previous lower speak or program and
in their own re caesarean (august) segment caesarean understand website
health care delivery after Clinician section, English
having had a office no current obstetric Decision-
caesarean problems, Analysis
delivery delivery expected at Program
>= 37 weeks
NS = Not specified, Yr = year, CHESS = Comprehensive Health Enhancement Support System
G-265
Evidence table 32. Description of RCTs addressing the impact of CHI applications on relationship-centered outcomes (continued)
Reference List
1. Green MJ, Peterson SK, Baker MW et al. Use of an educational computer program before genetic counseling for breast cancer susceptibility: effects on
duration and content of counseling sessions. Genet Med 2005; 7(4):221-9.
2. Gustafson DH, Hawkins R, Mctavish F et al. Internet-based interactive support for cancer patients: Are integrated systems better? 2008; 58(2):238-57.
3. Gustafson DH, Hawkins R, Pingree S et al. Effect of computer support on younger women with breast cancer. J Gen Intern Med 2001; 16(7):435-45.
4. Maslin AM, Baum M, Walker JS, A'Hern R, Prouse A. Using an interactive video disk in breast cancer patient support. Nurs Times 1998; 94(44):52-5.
5. Brennan PF, Moore SM, Smyth KA. The effects of a special computer network on caregivers of persons with Alzheimer's disease. Nurs Res 1995;
44(3):166-72.
6. Flatley-Brennan P. Computer network home care demonstration: a randomized trial in persons living with AIDS. Comput Biol Med 1998; 28(5):489-508.
7. Sciamanna CN, Harrold LR, Manocchia M, Walker NJ, Mui S. The effect of web-based, personalized, osteoarthritis quality improvement feedback on
patient satisfaction with osteoarthritis care. Am J Med Qual 2005; 20(3):127-37.
8. Montgomery AA, Emmett CL, Fahey T et al. Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled
trial. BMJ 2007; 334(7607):1305.
G-266
Evidence Table 33. Description of consumer characteristics in RCTs addressing KQ 1c (impact of CHI applications on relationship-centered outcomes)
Control
Author, Education, Gender,
year Intervention Age Race, n(%) Income n(%) SES n(%) Marital Status Other
Breast cancer
Green, Counseling Mean, 44 White non- NS College grad, NR Religion
1
2005 without range, 24-71 Hispanic, 53 (50) Catholic, 27 (26)
computer 100(95) Protestant , 52 (50)
intervention Jewish, 7 (7)
Computer use at
work
Often or sometimes,
71 (72)
Computer use,
personal affairs
Often or sometimes,
63 (61)
Very Confident
computer skills.
39 (37)
Counseling & Mean, 45 White non- NS College grad, NR Religion
Interactive range, 23-77 Hispanic, 65 (62) Catholic, 38 (37)
computer 100(95) Protestant, 45 (44)
program Jewish, 7 (7)
Computer use, work
Often or sometimes,
83 (82)
Computer use,
personal
Often or sometimes,
68 (65)
Very Confident
computer skills,
44 (42)
Gustafson, Usual Care NS NS NS NR NS
20082 with books
CHESS NS NS NS NR NS
Gustafson, Allocated Mean, 44.4 White non- USD Bachelor’s NR Living with Insurance
20013 standard SD, 7.1 Hispanic, (72) >40,000, degree, (40.2) Partner, (72.6) Private Insurance,
intervention (50.8) (84.7)
Received Mean, 44.3 White non- USD Bachelor’s NR Living with Insurance
CHESS SD, 6.6 Hispanic, (76) 40,000, degree, (45.8) Partner, (71.9) Private Insurance,
intervention, a (58.1) (86)
home based
computer
G-267
Evidence Table 33. Description of consumer characteristics in RCTs addressing KQ 1c (impact of CHI applications on relationship-centered outcomes) (continued)
Control
system
Maslin, Standard care Mean, 52.1 NS NS NS NR NS
4
1998 Interactive NS NS NS NR NS
Video Disk for
shared
decision
making
Brennan, Comparison Mean, 64 White non- NS (86) NR F, (67)
5
1995 group Hispanic, (72)
Computer NS NS NS NR NS
Link
HIV/AIDS
Flatley- Received Mean, 34 White non- NS mean, 14 NR Living Alone
Brennan, brochure SD, 10.8 Hispanic, (58) SD, 2.7
6
1998 Received mean, 33 White non- NS mean, 13 NR Living Alone
Computer SD, 7.3 Hispanic, (64) SD, 2.6
Link
Arthritis
Sciamanna, Completed Mean, 49.3 White non- NS 14 (24.6) NR F,
20057 questionnaire Hispanic, 50 41 (71.9)
before (87.7) M,
intervention black non- 16 (28.9)
Hispanic, 4 (7)
Latino/
Hispanic, 1
(1.8)
API, 0, (0)
AIAN, 1, (1.8)
Patient Mean, 46.6 White non- NS 17 (26.6) NR F,
satisfaction Hispanic, 55, 52 (81.3)
survey (85.9) M,
administered Black non- 12 (18.7)
after Hispanic, 4
participating (6.3)
in the web- Latino/Hispanic,
based 3 (4.7)
intervention AIAN, 2 (3.1)
Montgomery, Usual Care Mean, 32.4 NS Pound Highest NR Previous caesarean
20078 SD, 4.6 <20, 42 Educational section
G-268
Control
(18) Qualification Elective, 62(25)
20-30, 53 None, 12 (5) Emergency, 184(75)
(23) GCSE, 99 (40) Decisional conflict
30-40, 51 A level, 42 (17) scale (total) SD, 17.1
(22) Degree,92 (38) Preferred mode of
40-50, 43 delivery
(18) Vaginal, 111(45)
>50, 46 Elective caesarean,
(20) 53(21)
Unsure, 83(34)
Computerized Mean, 32.8 NS Pounds Highest NR Previous caesarean
Educational SD, 4.7 <20, 44 Educational section
Information (19) Qualification elective, 55(22)
20-30, 57 None, 10(4) emergency, 192(78)
(24) GCSE, 92(37) Decisional conflict
30-40, 46 A level, 47(19) scale (total)
(19) Degree, 97(39) mean, 40.2
40-50, SD, 16.6
37 (16) Preferred mode of
>50, delivery
52 (22) Vaginal, 112(45)
Elective caesarean,
52(21)
Unsure, 86(34)
Decision Mean, 32.5 NS Pounds Highest NR Previous caesarean
analysis SD, 4.8 <20, Educational section
program 48 (20) Qualification Elective, 49(20)
20-30, None, 7(3) Emergency, 193(80)
49 (21) GCSE, 97(40) Decisional conflict
30-40, A level (36(15) scale (total)
44 (19) Degree, mean, 37.8
40-50, 103(42) SD, 17.2
46 (19) Preferred mode of
>50, delivery
50 (21) Vaginal, 111(45)
Elective caesarean,
50(20)
Unsure, 84(34)
NR= Not Reported, NS= Not Significant, SD= Standard Deviation, SES= Socioeconomic Status, Yr= year, AIAN = American Indian/Alaska Native, API = Asian/Pacific Islander,
GCSE= General Certificate of Secondary Education
G-269
Reference List
44(3):166-72.
trial. BMJ 2007; 334(7607):1305.
G-270
Evidence Table 34. Outcomes in studies addressing the impact of CHI applications on relationship-centered outcomes
Control Measure Measure at ratios at

Author, Measure at Measure at at time Measure at final time time
year Outcomes Intervention n BL time point 2 point 3 time point 4 point points Significance
Breast Cancer
Green, 20051 Alter content Control 105 After
of counseling
discussions session with
genetic
counselor
Counseling & 106 After 0.03
Interactive counseling
computer session with
program genetic
counselor:100
Change the Control 105 After
way they counseling
used their session with
time genetic
counselor
Counseling & 106 After
program genetic
counselor:100
Used time Control 105 After
more counseling
efficiently session with
genetic
counselor
program genetic
counselor:100
Skip material Control 105 After
typically counseling
present session with
genetic
counselor
G‐271

Evidence Table 34. Outcomes in studies addressing the impact of CHI applications on relationship-centered outcomes (continued)

program genetic
counselor:100
Effectiveness Control 105 After
of counseling counseling
session session with
genetic
counselor
Counseling & 106 After Final time
Interactive counseling point, 0.81
computer session with (patients)
program genetic and 0.45
counselor:100 (counselors)
Shorter Control 105 After
counseling counseling
sessions session with
genetic
counselor
Counseling & 106 After Final time
Interactive counseling point, 0.03
program genetic
counselor
Gustafson, Social Control 80 Quality of life 9 month: BL,
20082 support mean, 0.18 mean, 0.11 .058
SD, 0.53 SD, 0.45 .039
.126
Time point 2,
.24
.004
.32
Final time
point, .018
.021
.028
Internet 75 Quality of life 9 month: BL,
mean, -0.02 mean, 0.07 .84
SD, 0.56 SD, 0.45 .39
.69
Time point 2,
G‐272


.44
.77
.53
Final time
point, .33
.57
.48
CHESS 80 Quality of life 9 month: BL, .029
mean, 0.02 mean, 0.18 .003
SD, 0.54 SD, 0.54 .007
Time point 2,
0.47
.027
.15
Final time
point, .14
.14
.16
Quality of life Control 80 Social 4 month 9 month
support: mean, 0.13
mean, 0.23 SD, 0.54
SD, 0.49
Internet 75 social 4 month 9 month
support: mean, 0.06
mean, -0.08 SD, 0.58
SD, 0.56
CHESS 80 Social 4 month 9 month
support: mean, 0.21
mean, 0.16 SD, 0.55
SD, 0.49
Health Control 80 Health and 4 month 9 month
competence information mean, 0.12
competence SD, 0.37
mean, 0.17
SD, 0.39
Internet 75 Health and 4 month 9 month
information mean, 0.06
competence SD, 0.49
mean, -0.03
SD, 0.48
G‐273


CHESS 80 Health and 4 month 9 month
information mean, 0.18
competence SD, 0.48
mean, 0.12
SD, 0.47
Gustafson, Information Control 125 2 month 5 month: Time point 2,
3
2001 competence mean, 65.6 mean, 65.8 0.01
Chess 121 2 month 5 month: Time point 2,
mean, 70.4 mean, 69.3 0.01
Participation Control 125 2 month 5 month time point 2,
mean, 74.3 0.01
CHESS 121 2 month 5 month Time point 2,
mean, 80.7 0.01
Control 125 2 month 5 month Time point 2,

mean, 74.3 0.01
CHESS 121 2 month 5 month Time point 2,

mean, 80.7 0.01
Confidence Control 125 2 month 5 month Time point 2,
in doctors mean, 77.3 0.05
CHESS 121 mean, 83 2 month RR or 5 month

OR time
point 3,
0.05
Maslin, 19984 Anxiety and Interactive 51 Score on 9 months later
depression Video Disk HAD
for shared
decision
making
51 9 months later
Satisfaction Control 51 9 months after
with diagnosis
treatment Interactive 51 9 months after
decision Video Disk diagnosis
for shared
G‐274


decision
making

Brennan, Decision Control 49 Likert scale, 12 months:
19955 confidence 14 items, 5 mean, 54.7
choices SD, 6.1
mean, 54.65
SD, 7.3
ComputerLink 47 Likert scale 12 months: <.01
14 items, 5 mean, 56.8
choices SD, 7
mean, 51.9
SD, 6
Improved Control 49 Number of 12 months
decision alternatives mean, 2.37
making skill caregiver SD, 78
considers to
solve a
problem:
mean, 2.51
SD, 0.91
ComputerLink 47 Number of 12 months 0.2
alternatives mean, 2.4
caregiver SD, 0.61
considers to
solve a
problem:
mean, 2.53
SD, 0.78
Isolation Control 49 Score on 12 months
Instrumental mean, 62.6
and SD, 16
Expressive
Support Scale
(IESS)
mean, 62.7
SD, 15.5
ComputerLink 47 mean, 63.4 12 months 0.51
SD, 16.6 mean, 65
G‐275


SD, 17.4
HIV/AIDS
Flatley- Improved Control 26 Mean score Post- BL, 0.05
Brennan, decision mean, 52.8 intervention: time point 2,
19986 making SD, 6 mean, 56.47 final time
confidence SD, 4.2 point, 0.05
Computer 31 Mean score Post- BL, 0.05
Link mean, 54.35 intervention: time point 2,
SD, 5.9 mean, 51.45 final time
SD, 6.9 point, 0.05
Improved Control 26 Mean score: Post- BL, 0.05
decision mean, 4.73 intervention time point 2,
making skill SD, 1.4 mean, 5.47 final time
Reduced SD, 1.3 point, 0.05
social Computer 31 Mean Score: Post- BL, 0.05
isolation Link mean, 4.58 intervention time point 2,
SD, 1.5 point, 0.05
Control 26 Mean score Post- BL, 0.05
SD, 17 mean, 68 final time
SD, 16.8 point, 0.05
Computer 31 Mean score Post- BL, 0.05
Link mean, 63.5 intervention time point 2,
SD, 13.68 point, 0.05
Differential 26 Mean score Post- BL, 0.05
decline in mean, 13.8 intervention final time
health status SD, 4.93 mean, 13.65 point, 0.05
SD, 1.3
Computer 31 RR or OR Post- BL, 0.05
Link time point 2, intervention time point 2,
0.05 mean, 13 No
SD, 1.7 improvement
over control
Arthritis
Sciamanna, Patient Control 57 One
20057 overall measurement
satisfaction only, survey
G‐276


score with before or after
the viewing the
osteoarthritis web-based
care they are module
receiving www.myexpert 64 One BL, No diff
doctor.com measurement between
tailored only, survey control &
feedback on before or after intervention
quality of viewing the group
web-based time point 2,
received care
module: final time
point
Montgomery, mean (SD) Usual Care 201 Total score 37 weeks
20078 on DCS at on DCS gestation
follow up (DCS):
mean, 27.8
SD, 14.6
Computerized 201 Total score 37 weeks
Educational on DCS gestation
Information (DCS):
mean, 22.5
SD, 13.2
Decision 198 Total score 37 weeks
analysis on DCS gestation
program (DCS):
mean, 23.6
SD, 15.1
Difference Usual Care 201 Difference 2 weeks time point 4, 37 weeks 0.22
between between post delivery OR:1.42(0.94 gestation
groups in groups on (satisfaction to 2.14) (DCS)
total score on total score on with mean, -4
DCS DCS(adjusted decision) range,
(decision v figure -6.5 to -1.5
usual care)
Odds ratio Computerized 201 Odds ratio for 2 weeks 37 weeks
for Educational vaginal v c post delivery gestation
caesarean Information section (satisfaction (DCS)
(elective and (elective and with
emergency) emergency) decision)
G‐277


v vaginal, decision
decision v analysis v
usual care usual care
Decision 2 weeks 37 weeks
analysis post delivery gestation
program (satisfaction (DCS)
with
decision)
Usual Care 2 weeks 37 weeks
post delivery gestation
(satisfaction (DCS)
with
decision)
Computerized 2 weeks 37 weeks
Educational post delivery gestation
Information (satisfaction (DCS)
with
decision)
Satisfaction Decision 201 Satisfaction 2 weeks 37 weeks 0.063
with decision analysis with decision post delivery gestation
(decision program as odds ratio (satisfaction (DCS)
analysis v (decision with mean, 0.14
usual care) analysis v decision) range,
usual care) 0.02 to 0.27
Mode of Usual Care 201 6 weeks questionnaire Hospital
delivery - post delivery at 36 weeks records: type
elective gestation of delivery:50
caesarean Computerized 201 6 weeks questionnaire Hospital
Educational post delivery at 36 weeks records: type
Information gestation of delivery:49
Decision 198 6 weeks questionnaire Hospital
analysis post delivery at 36 weeks records: type
program gestation of delivery:41
Delivery - Usual Care 238 6 weeks questionnaire Hospital
emergency post delivery at 36 weeks records: type
caesarean gestation of delivery:20
Computerized 240 6 weeks questionnaire Hospital
G‐278


Delivery - Usual Care 238 6 weeks questionnaire Hospital
vaginal birth post delivery at 36 weeks records: type
gestation of delivery:30
Computerized 240 6 weeks questionnaire Hospital
BL = baseline, SD = standard deviation, OR = odd ratio, RR = relative ratio, DCS = decisional conflict scale
Reference List
44(3):166-72.
trial. BMJ 2007; 334(7607):1305.
G‐279

Evidence Table 35. Description of RCTs addressing KQ1d (impact of CHI applications on clinical outcomes)
Year data
Alzheimer’s
Tarraga, Individuals Interactive Clinician NS > 65 yr, Uncontrolled ChEI control Integrated 0
20061 interested consumer office treated with CHEI x disruptive psycho
in their own website 1 yr, behaviors (e.g., stimulation
health care > 3 yrs education, aggression, program,
MMSE 18-24, delusions,
a Global hallucinations and Interactive
Deterioration Scale agitation) that Multimedia
(GDS) score of 3 or could interfere Internet-based
4, with program System (IMIS)
absence of administration
uncontrolled and/or
disruptive behaviors, neuropsychologic
absence of major al assessments,
depression, major depression,
absence of structural current or partial
lesions in the remission,
computed structural lesions
tomogram, in the computed
absence of history of tomogram or
alcohol or the magnetic
substance abuse resonance image,
history of alcohol
or other substance
abuse,
severe auditory,
visual or motor
deficits that may
interfere with
cognitive testing
Arthritis
Lorig, Individuals Interactive NS 2004/ 18 and older, Active treatment Usual care Online 1
20082 interested consumer NS a diagnosis of OA, for cancer for 1 yr, intervention
in their own website rheumatoid arthritis participated in the
health care (RA), small-group
or fibromyalgia, ASMP or the
could have other Chronic Disease
chronic conditions Self-Management
Internet and email Program
access
G-280
Evidence Table 35. Description of RCTs addressing KQ1d (impact of CHI applications on clinical outcomes) (continued)
Year data
agreed to 1–2 hours
per week of log-on
time spread over at
least 3
sessions/week for 6
weeks
Asthma
Jan, Individuals Personal Home/ 2004/ 6 - 12 yr, Diagnosed with Verbal Blue Angel for 1
20073 interested monitoring residence January to caregivers have bronchopulmonary information Asthma Kids,
health care persistent asthma diagnosed with for asthma An internet-
diagnosis (GINA other chronic co education based diary
Caregiver, clinical practice morbid conditions with written record for
childhood guidelines) that could affect asthma peak
asthma quality of life diary. expiratory flow
rate (PEFR)
symptomatic
support
information,
and an action
plan
suggestion,
and
telecommunic
ation
technologies
for uploading
and retrieving
the storage
data
Back pain
Buhrman, Individuals Interactive Home/ NS, 18-65 yr, Suffer of pain that Wait-list Internet-based 2
20044 interested consumer residence Internet access, can increase as a pain
in their own website Been in contact with consequence of management
health care a physician, activity, program
Have back pain, wheelchair bound,
Have chronic pain have planned any
(>3 months), surgical treatment,
suffer from heart
G-281
Year data
and vascular
disease
Breast cancer
Gustafson, Individuals Interactive Home/ Duration, <60 years, Allocated Received 1
20015 interested consumer residence Between Breast cancer standard CHESS
in their own website, April 1995 patients, intervention intervention
health care and May Within 6 months of
1997 diagnosis,
not homeless,
not active illegal
drug users,
Gustafson, Individuals Interactive Home/ Between <60 years, Allocated Received 2

diagnosis,
not homeless,
not active illegal
drug users
Maslin, Individuals Interactive Clinician NS Non metastatic Advanced breast Standard Interactive -1
19987 interested computerized office breast cancer, cancer, care computerized
in their own video system metastatic video system
health care disease,
sensory
impairment,
do not understand
English,
Chronic adult aphasia
Katz, Individuals Interactive Clinician NS <85 years, Visual acuity No treatment Computer 1
19978 interested consumer office aphasia subsequent better than 20/100 stimulation,
in their own website to a single left corrected in the Computer
health care hemisphere, better eye, reading
thromboembolic auditory acuity treatment
infarct, better than 40 dB
completed at least speech reception
8th grade, threshold,
pre-morbidly literate language
in English, treatment in the
living in non- three months prior
G-282
Year data
institutionalized to entry into the
environment, study
at least one year
post-onset of
aphasia,
performs between
15th and 90th
overall percentile on
the Porch Index of
communicative
Ability,
Pre-morbidly right-
handed
COPD
Nguyen, Individuals Interactive Academic 2005/ NS Diagnosis of COPD Any active Face-to-face Internet-based 2
9
2008 interested consumer medical and being clinically symptomatic (fDSMP) (eDSMP)
in their own website, centers stable for at least 1 illness,
health care month, participated in a
spirometry results pulmonary
showing at least mild rehabilitation
obstructive disease, program in the last
ADL limited by 12 months,
dyspnea, were currently
use of the Internet participating in > 2
and/or checking days of
email at least once supervised
per week with a maintenance
windows operating exercise
system,
oxygen saturation >
85% on room air or
¡Ü 6 L/min of nasal
oxygen at the end of
a 6-minute walk test,
Headache
Trautman, Individuals Interactive Home/ NS 10-18 yr, EDU (First CBT (6 self- 3
200810 interested consumer residence At least two training help sessions
in their own website headache attacks session of and 6 weekly
health care per month CBT on chat sessions
G-283
Year data
headache with trainer)
Parents/car information
egivers plus chat
communicati
on)
Mental health/Depression
Christensen, Individuals Interactive NS NS >18 years, > 52 years, Control Mood GYM 2
11
2004 interested consumer internet access, receiving clinical
in their own website 22 or higher on the care from either a Blue Pages
health care Kessler psychologist or
psychological psychiatrist
distress scale
Hasson, Individuals Personal NS NS Employment at a Those who quit Access to Web-based 2
200512 interested monitoring company insured by employment prior web-based tool with
in their own device Alecta (occupational to completion of tool control group
health care pension plan study, including components
company) "communication monitoring plus self-help
related problem" tool for with stress
stress and management
health; diary exercises and
connected to chat
monitoring
tool, and
scientific info
on stress
and health
Kerr, Individuals Interactive Home/ NS 18 - 25 years, Enhanced PACEi 1
200813 interested consumer residence BMI 25-39 standard
in their own website care
health care
March, Individuals NS NS 7 - 12 yr, Developmental Wait list 2
14
2008 interested primary diagnosis of disorders, (WL)
in their own an anxiety disorder learning disability,
health with severity level of depressive
care: 4 or more on 8 point disorder,
children scale ( I-e moderate other
parents severity), psychological
a minimum reading treatment,
level of 8 years primary behavioral
access to internet at disorder,
G-284
Year data
home failure to complete
screening
assessment
Orbach, Interactive Remote NS Both, Receiving Control CBT 1
200715 consumer location: students in Kings treatment for
website, university College London, anxiety,
campus London University,
access to a
computer connected
to the Internet
Proudfoot, Individuals Personal Clinician NS 18-75 years old, Psychological Usual Beating the 3
16
2003 interested monitoring office depression, treatment or treatment Blues
in their own device anxiety and counseling, intervention
health care depression, current Suicidal
Anxiety, ideation,
>=4 on General psychotic disorder
Health organic mental
Questionnaire-12, disorder,
>=12 on Clinical alcohol and/or
Interview Schedule- drug dependence,
Revised on medication for
anxiety and/or
depression for
>=6 months
immediately prior
to entry,
unable to read or
write,
unable to attend 8
session at surgery
Spek, Individuals Interactive Home/ Duration, Age between 50 and Suffering from any Waiting list Group CBT, 2
17
2008 interested consumer residence 12months 75 years, other psychiatric control Internet-based
in their own website an Edinburgh disorder in intervention
health care Depression Scale immediate need of
(EDS) score of 12 or treatment and
more, no DSM-IV suicidal ideation
diagnosis of
depression,
access to the
internet and the
G-285
Year data
ability to use the
internet
Diabetes
Homko, Individuals Interactive Home/ Duration, 18-45 years, Prior history of Usual care, telemedicine 1
200718 interested consumer residence Sep 2004 to documented GDM glucose paper (website to
in their own website, May 2006 on 3-h oral glucose intolerance logbooks document
health care tolerance test, using outside of glucose levels
the criteria of pregnancy, and to
Carpenter and multiple gestations communicate
Coustan, with health-
33 weeks gestation care team)
or less
Tjam, 200619 Individuals Interactive Clinician 2years 65 yr, Below40 and Individuals Individuals 1
interested consumer office duration Both male and above65 years, with with
in their own website female, blindness, Diabetes interactive
health care Internet proficient little or no Education internet
have access, dexterity, Centers program
have access to education level program
internet below grade 5, n, 20
ESRD ,
gestational
diabetes
Wise, 1986 20 Diabetic Interactive Home / Ns Diabetics attending None specified 3 controls Interactive
Diabetes individuals computerized Res Charing Cross Used: computerized
both machine hospitaland having a. No machine
NIDDM DM > 2 yrs intervention
and IDDM (used for
Glucose
control
assessment)
No KAP
b. Just the
assessment
of the KAP
c. Take-
away
corrective
feedback
Diet/exercise/physical activity NOT Obesity
Adachi, Individuals Tailored Home/ 2002/ 20-65 yr, Untailored behavioral 0
G-286
Year data
200721 interested advice based residence January to BMI ≥24, self-help weight control
in their own on answers to September BMI r≥ 23 with mild booklet with program with
health care a hypertension 7-month self 6
questionnaire Hyperlipidemia, monitoring
or DM
Hunter, Individuals Interactive NS Year, 2006 18 - 65 yr, Lost more than 10 Usual care behavioral 2
200822 interested consumer weight within 5 pounds in the Internet
in their own website, pounds or above previous 3 treatment
health care their maximum months,
allowable weight used prescription
(MAW) for the or over-the-
USAF, counter weight-
personal computer loss medications
with internet access, in the previous 6
plans to remain in months,
the local area for 1 had any physical
year, activity
restrictions,
had a history of
myocardial
infarction,
stroke,
or cancer in the
last 5 years,
reported diabetes,
angina,
or thyroid
difficulties; or had
orthopedic or joint
problems,
women were
excluded if they
were currently
pregnant or
breast-feeding,
or had plans to
become pregnant
in the next year
McConnon, Individuals Interactive Home/ 2003/ NS 18 - 65 yr, Usual care Internet group 1
200723 interested consumer residence BMI 30 or more,
G-287
Year data
in their own website, able to access
time a week,
able to read and
write English
Tate, Individuals Interactive Clinician NS, 20 to 65, Heart attack, No human email 4
200624 interested consumer office body mass index of stroke, counseling counseling,
in their own website 27 to 40, or cancer in the automated
health care willingness to use past 5 years, feedback
meal replacements diabetes,
as part of the dietary angina
regimen, or orthopedic or
availability of a joint problems that
computer with would prohibit
internet access exercise,
major psychiatric
disorder involving
hospitalization
during the past
year,
current,
planned,
or previous (within
6 months)
pregnancy
Williamson, Individuals Interactive Clinician NS 11 - 15 yr, Control and control and 2
200625 interested consumer office African-American, intervention intervention
in their own website female, adolescents parents
health care BMI above the 85th
percentile for age
and gender based
on 1999 National
Health and Nutrition
Examination Study
normative data,
at least one obese
biological parent,
as defined by BMI >
30,
one designated
G-288
Year data
parent who was
overweight (BMI >
27),
adolescent’s family
was willing to pay
$300 out-of pocket
expenses toward the
purchase of the
computer worth
>$1000,
the family home had
electricity and at
least one functional
telephone line
HIV AIDS
Gustafson, Individuals Interactive Home/ NS Dementia, No Received 2
199926 interested consumer residence Control subject intervention access to
in their own website with room mate in CHESS
health care experimental
group
Pain Tolerance
Borckardt, Individuals Computer Remote; NS Distraction Computerized 0
27
2007 interested assisted Sound group Pain
in their own imagery proof lab Management
health care system at the
university
Obesity
Morgan, Overweight Interactive Home / Sept to Dec Consenting Male H/o major medical One SHED IT
2009 28 and obese website Res 2007 individuals from U of problem like heart information internet
Obesity males Newcastle disease in past 5 session + program w/
responding to adv years, DM, Program information
who were obese / orthopedics or booklet session and
overwt (BMI 25— joint problem that program
37), 18—60 y/o. would be a barrier booklet (the
to PA, recent program
weight loss of 4.5 facilitates self
kg or consuming monitoring
meds affecting and daily diary
body wt. to which the
researchers
G-289
Year data
respond)
NS = not specified, yr = year, CHESS = Comprehensive Health Enhancement Support System, CBT = computer based training, eDSMP = Internet based dyspnea self-management
programs, fDSMP = face-to-face dyspnea self-management programs, BMI = body mass index
Reference List
1 Tarraga L, Boada M, Modinos G et al. A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in
Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006; 77(10):1116-21.
111(3):368-77.
5 Gustafson DH, Hawkins R, Pingree S et al. Effect of computer support on younger women with breast cancer. J Gen Intern Med 2001; 16(7):435-45.
6 Gustafson DH, Hawkins R, Mctavish F et al. Internet-based interactive support for cancer patients: Are integrated systems better? 2008; 58(2):238-57.
7 Maslin AM, Baum M, Walker JS, A'Hern R, Prouse A. Using an interactive video disk in breast cancer patient support. Nurs Times 1998; 94(44):52-5.
8 Katz RC, Wertz RT. The efficacy of computer-provided reading treatment for chronic aphasic adults. J Speech Lang Hear Res 1997; 40(3):493-507.
9 Nguyen HQ, Donesky-Cuenco D, Wolpin S et al. Randomized controlled trial of an internet-based versus face-to-face dyspnea self-management program
10 Trautmann E, Kro?ner-Herwig B. Internet-based self-help training for children and adolescents with recurrent headache: A pilot study. 2008; 36(2):241-5.
11 Christensen H, Griffiths KM, Jorm AF. Delivering interventions for depression by using the internet: randomised controlled trial. BMJ 2004; 328(7434):265.
12 Hasson D, Anderberg UM, Theorell T, Arnetz BB. Psychophysiological effects of a web-based stress management system: a prospective, randomized
G-290
13 Kerr J, Patrick K, Norman G et al. Randomized control trial of a behavioral intervention for overweight women: impact on depressive symptoms. Depress
Anxiety 2008; 25(7):555-8.
14 March S, Spence SH, Donovan CL. The Efficacy of an Internet-Based Cognitive-Behavioral Therapy Intervention for Child Anxiety Disorders. J Pediatr
Psychol 2008.
15 Orbach G, Lindsay S, Grey S. A randomised placebo-controlled trial of a self-help Internet-based intervention for test anxiety. Behav Res Ther 2007;
45(3):483-96.
16 Proudfoot J, Goldberg D, Mann A, Everitt B, Marks I, Gray JA. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and
depression in general practice. Psychol Med 2003; 33(2):217-27.
17 Spek V, Cuijpers P, Nyklicek I et al. One-year follow-up results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for
subthreshold depression in people over 50 years. Psychol Med 2008; 38(5):635-9.
19 Tjam EY, Sherifali D, Steinacher N, Hett S. Physiological outcomes of an internet disease management program vs. in-person counselling: A randomized,
controlled trial. 2006; 30(4):397-405.
2007; 7:206.
(Silver Spring) 2006; 14(7):1231-43.
26 Gustafson DH, Hawkins R, Boberg E et al. Impact of a patient-centered, computer-based health information/support system. Am J Prev Med 1999; 16(1):1-
9.
G-291
27 Borckardt JJ, Younger J, Winkel J, Nash MR, Shaw D. The computer-assisted cognitive/imagery system for use in the management of pain. Pain Res Manag
2004; 9(3):157-62.
G-292
Evidence Table 36. Description of consumer characteristics in RCTs addressing KQ 1d (impact of CHI applications on clinical outcomes)
Control Marital
Author, Education, Gender, Status,
year Interventions Age Race, n(%) Income n(%) SES n(%) n(%) Other
Alzheimer’s
Tarraga, ChEI control Mean, 76.9 NS NS NS NR F,12
1
2006 SD, 4.5
Integrated psycho Mean, 77.4 NS NS NS NR F,14
stimulation SD, 4.7
program (PPI)
Interactive Mean, 75.8 NS NS NS NR F,13
multimedia SD, 5.9
internet-based
system (IMIS)
Arthritis
Lorig, Usual care Mean, 52.5 White non- NS Mean, 15.7 NR F, Married, Health-related
2
2008 range 22–89 Hispanic, SD, 3.11 425(90.5) 425(71.1) web site visits
SD, 12.2 425(93.7) last 6 months:
mean, 2.85
SD, 11.68
Online intervention Mean, 52.2 White non- NS Mean, 15.6 NR F, Married, Health-related
SD, 10.9 Hispanic, SD, 3.09 441(89.8) 441(65.5) web site visits
441(90.9) last 6 months
mean, 2.87
SD, 11.2
Asthma
Jan, Verbal information Mean, 9.9 NS NS NS NR M,28(36.8) History of
20073 and booklet for SD, 3.2 F, 48(63.2) asthma (yr):
asthma education mean, 2.1
with written SD, 1.2
asthma diary. Asthma
severity:
mild, 33(43.4)
moderate,
35(46.1)
severe, 8(10.5)
Education of
primary
caregiver:
HS diploma or
below,
43 (56.6)
College or
above,
G‐293

Evidence Table 36. Description of consumer characteristics in RCTs addressing KQ 1d (impact of CHI applications on clinical outcomes) (continued)
Control Marital
33 (43.4)
Participant Mean, 10.9 NS NS NS NR M,35(39.7) History of
received asthma SD, 2.5 F, 53(60.2) asthma (yr):
education and with mean, 2.4
interactive asthma SD, 1.9
monitoring system Asthma
severity:
mild, 33(37.5)
moderate,
43(48.9)
severe,
12(13.6)
Education of
primary
caregiver:
HS diploma or
below,
58(66.0)
College or
above, 30
(34.0)
Back pain
Buhrman, Wait-list Mean, 45 NS NS <8 yr, 7(24.1) NR M,11(37.9) Sick leave:
20044 SD, 10.7 8-12 yr, 6(21) F, 18(62.1) Yes,
12-14 yr, 12 (41.4)
2 (6.9) No,
14-16 yr, 17 (58.6)
14 (48.3) Pain location:
back,
12 (41.4)
back plus
other area,
17 (58.6)
Previous
treatment:
PT,11(37.9)
chiropractor,
12 (41.4)
nephropathy,
3 (10.3)
G‐294

Control Marital
Psychologist,
6 (20.7)
Pain Clinic,
2 (6.9)
Internet-based Mean, 43.5 NS NS <8 yr, 2 (9.1) NR M, 8 (36.4) Sick leave:
pain management SD, 10.3 8-12 yr, 6 (27) F,14 (63.6) Yes, 5 (22.7)
program 12-14 yr, No, 17 (77.3)
3 (13.6) Pain location:
14-16 yr, back, 7 (31.8)
11 (50) back plus
other area, 15
(68.2)
Previous
treatment:
PT, 10 (45.5)
chiropractor,
8 (36.4)
naprapathy,
4 (18.2)
Psychologist,
3 (13.6)
Pain Clinic,
1 (4.5)
Breast cancer
Gustafson, Allocated standard Mean, 44.4 White non- USD 12-16 yr NR Living Insurance:
20015 intervention median, Hispanic, 72 >40,000, (40.2) Status: private
range, 50.8% Living with Insurance,
SD, 7.1 Partner, (84.7)
(72.6)
Received CHESS Mean, 44.3 White non- USD 12-16 yr NR Living Insurance:
intervention, a median, Hispanic, 76 >40,000, (45.8) Status: private
home based range, (58.1) Living with Insurance, (86)
computer system SD, 6.6 Partner,
(71.9 )
Gustafson, Usual Care with NS NS NS NS NR NS
6
2008 books
Internet NS NS NS NS NR NS
Maslin, Standard care Mean, 52.1 NS NS NS NR NS
19987
IVD shared NS NS NS NS NR NS
G‐295

Control Marital
decision program
Katz, No treatment Mean, 62.8 NS NS Mean, 13.6 yr NR NS
19978 range, 53-70 SD, 2.2
SD, 5.1
Computer Mean, 66.4 NS NS mean, 15 NR NS
stimulation range, 53-76 SD, 2.8
SD, 6
Computer reading Mean, 61.6 NS NS Mean, 14.4 NR NS
treatment range, 48-83 SD, 3.3
SD, 10
COPD
Nguyen, Face-to-face Mean, 70.9 White non- NS 12-16 yr, 8(40) NR F, 9 (45) Not currently
9
2008 (fDSMP), SD, 8.6 Hispanic, >16 yr, 12(60) employed or
20(100) currently
disabled or
retired,
15 (75)
currently
smoking,
1 (5)
eDSMP Mean, 68 White non- NS 12-16 yr, NR F, 8(39) Not currently
SD, 8.3 Hispanic, 10(50) employed or
18 (95) >16 yr, currently
9(50) disabled or
retired:
13 (72)
currently
smoking:
2 (11)
Headache
Trautman, EDU (First training NS NS NS NS NR NS NS NS
10
2008 session of CBT on
headache
information plus
chat
communication)
Mean, 13.4 NS NS NS NR NS NS NS
range, 10-18
SD, 2.6
G‐296

Control Marital
Mean, 13.4 NS NS NS NR NS NS NS
range, 10-18
SD, 2.6
Mental health/ Depression
Christensen, Control Mean, 36.29 NS NS Mean, 14.4 NR F, 124 (70) Married Kessler
200411 SD, 9.3 SD, 2.3 M, 54 (30) cohabiting: Psychological
100 (56) Distress Scale:
Divorced/se mean, 18
parated: 24 SD, 5.7
(14)
Never
married:
53 (36)
Mood gym Mean, 35.85 NS NS Mean, 14.6 NR F, 136 (75) Married/ Kessler
SD, 9.5 SD, 2.4 M, 46 (25) cohabiting: Psychological
98 (54) Distress Scale:
Divorced/se mean, 17.9
parated: SD, 5
26 (14)
Never
married:
57 (31)
Blue Pages Mean, 37.25 NS NS Mean, 15 NR F, 115 (69) Married/coh Kessler
SD, 9.4 SD, 2.4 M, 50 (31) abiting: 100 Psychological
(61%) Distress Scale:
Divorced/se mean, 17.5
parated: median,
24(15) SD, 4.9
Never
Married:
53 (30)
Hasson, Access to web- NS NS US D 8-12 yr, 89 NR M, Marital
12
2005 based tool <25,000, (51) 112 (64) status:
including 39 (22) 12-16 yr, 83 F, Married,
monitoring tool for 25,000- (48) 62 (36%) 134 (77)
stress and health; 40,000, Single:
diary connected to 106 (61) 38 (22
monitoring tool, >40,000,
and scientific info 27 (16)
on stress and
G‐297

Control Marital
health
NS NS USD 8-12 yr, 54 NR M, Marital
<25,000, (42), 75 (58) status:
24 (18) 12-16 yr, F, Married:
25,000- 73 (57) 54 (42) 102 (79)
40,000, Single:
76 (59) 25 (19)
>40,000,
27 (21)
Kerr, Enhanced Mean, NS NS 81(14.3) NR Married or Full-time
13
2008 standard care. 41.6(8.9) living with employed:
Standard care partner: yes, 140(71.4)
participants yes, Percent with
received usual 128(65.3) CESD score
advice from their 10 or greater:
provider yes 59(30.1)
concerning Physical
overweight; to activity:
change their mean baseline
physical activity total minutes
and eating habits. moderate &
They also received vigorous
a standard set of activity per
materials day:
summarizing mean, 23.15
recommendations
for diet and
exercise.
PACEi Mean, 40.8 NS NS 105(51.2) NR Married or Full-time
SD, 8.4 living with employed:
partner: 152 (74.0)
yes, percent with
140(68.5) CESD score
10 or greater:
50(24.4)
Physical
activity:
mean baseline
total minutes
moderate &
G‐298

Control Marital
vigorous
activity per
day:
mean, 21.05
March, Wait list (WL) Mean, 9.09 NS Australian NS NR F, 33(57.6)
200814 SD, 1.44 dollar M, 33(42.
<40,000,
33(12.5)
41,000–
60,000,
33(34.4)
61,000–
80,000,
33(15.5)
81,000–
100,000,
33(6.3)
>100,000,
33(31.3)
Internet-based Mean, 9.75 NS Australian NS NR F, 40(52.5)
CBT (NET) SD, 1.24 dollar M,40(47.5)
<40,000
40(21.1)
41,000–
60,000
40(26.2)
61,000–
80,000,
40(15.8)
81,000–
100,000,4
0(15.8)
>100,000,
40(21.1)
Orbach, Control Mean, 22.54 NS NS Yr at NR F, 24 (86) Years test
200715 range, 20.07– university: anxiety:
24.97 mean, 3.02 mean, 6.12
SD, 5.71 median, SD, 6.39
SD, 2.81 Failed exams:
14(50)
G‐299

Control Marital
CBT Mean, 24.72 NS NS NS NR F, 18 (60) Year at
range, university:
22.36–27.09 mean, 3.18
SD, 6.89 SD, 2.53
Years test
anxiety:
mean, 7.59
SD, 6.67
Failed exams:
15 (50)
Proudfoot, Usual treatment Mean, 45.7 Black Caribbean NS <5 yr, 1(1) NR F, Single,
16
2003 SD, 14.1 2 (3) 5-10yr, 10 (14) 57 (73.1) 20 (27)
Indian 3 (5) 11-12 yr, M, Married,
Pakistani 1 (2) 17(24) 21(26.9) 34 (45)
White 57 (88) 13-15yr, Cohabiting,
15 (21) 7 (9)
>15, 28(39) Separated,
2 (3)
Divorced,
8 (11)
Widowed,
4 (5)
Beating the Blues Mean, 43.7 Black African: NS <5yr, 0 NR F, Single,
intervention SD, 14.7 1(1) 5-10yr, 8 (10) 66 (74.2) 25 (29)
Black Caribbean 11-12 yr, M, Married,
2(3) 22 (26) 23 (25.8) 32 (37)
Black other 2 (3) 13-15yr, Cohabiting,
White 68 (88) 15 (18) 9 (11)
>15yr, 39 (46) Separated,
2(2)
Divorced.
13 (15)
Widowed,
5 (6)
Spek, Waiting list control Mean, 55 NS NS NS NR M, 110
200817 SD, 4.6 F, 191
NS NS NS NS NR NS
Diabetes
Homko, Usual care, Mean, 29.2 White non- USD < 8 yr, 2(8) NR BMI:
200718 paper logbooks SD, 6.7 Hispanic, 6(24) <15,000, 8-12 yr, 12(48) mean, 32.5
G‐300

Control Marital
Black non- 10(40) 12-16 yr, SD, 7.1
Hispanic, 12(48) 15,000- 10(40) Gravidity:
Latino/Hispanic, 34,999, mean, 2.9,
4(16) 3(12) SD, 2.3
API, 3(12) 35,000- Glucose
54,999, challenge
3(12) (mg/dl):
>55,000, mean, 179.1
3(12) SD, 45.2
missing, GA at
6(24) diagnosis
(weeks):
mean, 27.7
SD, 3.8
Telemedicine Mean, 29.8 White non- USD <8 yr, 4(12.5) NR BMI :
(website to SD, 6.6 Hispanic, 8(25) <$15,000, 8-12 yr, mean, 33.4
document glucose Black non- 8(25) 12(37.5) SD, 8.6
levels and to Hispanic, 14(44) $15,000- 12-16 yr, Gravidity:
communicate with Latino/Hispanic, $34,999, 15(47) mean, 3
health-care team) 7(22) 8(25) SD, 1.8
API, 3(9) $35,000- Glucose
$54,999, challenge
3(9) (mg/dl):
>$55,000, mean, 159.5
6(19) SD, 46.3
missing, GA at
7(22) diagnosis
(weeks):
mean, 27.5
SD, 4.2
Tjam, 200619 Individual with Range, 65 NS NS <8 yr, NR NS NS NS
Diabetes 8 (40)
Education Centers 8-12 yr,
(DEC) program 3 (15)
n,20 12-16 yr,
9 (45)
Individual with Range, 65 NS NS <8 yr, NR NS NS NS
interactive internet 8 (21.6)
program 8-12 yr,
5 (13.5)
G‐301

Control Marital
12-16 yr,
24 (64.9)
Wise, 1986 IDDM 42 +/- 16 NS NS NS Sex ratio
20
Diabetes varied from
0.42 to
0.60. The
study does
not specify
any other
detail
Control Group
(AGE +/- SE)
KAP
KAP –Feedback – 45 +/- 16

KAP
KAP –Interactive 41 +/- 18

computer –KAP
NIDDM 55 +/- 21 NS NS NS Sex ratio

varied from
0.42 to
0.60. The
study does
not specify
any other
detail
Control Group
(AGE +/- SE)
G‐302

Control Marital
KAP
KAP –Feedback – 58 +/- 17

KAP
KAP –Interactive 56 +/- 16

computer –KAP
Diet/exercise/physical activity not obesity

Adachi, Control Mean, 46.3 NS NS NS NR Height (cm):
21
2007 SD, 8.6 mean, 157.6
SD, (5.9)
Body weight
(kg):
mean, 65.1
SD, 6.4
BMI (kg/m2):
mean, 26.1
SD, 1.6
Behavioral weight Mean, 46.6 NS NS NS NR Height:
control program SD, 10.1 mean, 157.5
with 6-month SD, 6.1
weight and Body weight
targeted (kg):
mean, 65.3
SD, 6.4
BMI (kg/m2):
mean, 26.2
SD, 1.4
Untailored self- Mean, 46.6 NS NS NS NR Height:
help booklet with SD, 9 mean, 155.7
7-month self SD, 5.2
monitoring Body weight
(kg):
mean, 63.4
SD, 5.5
BMI (kg/m2):
mean, 26.1
G‐303

Control Marital
SD, 1.5
Hunter, Usual care Mean, 34.4 White non- NS 12-16 yr, NR F,
22
2008 SD, 7.2 Hispanic, 222(61.7) 222(50.5)
222 (53.2)
Behavioral Internet Mean, 33.5 White non- NS 12-16 yr, NR F,
treatment SD, 7.4 Hispanic, 224(63.9), 224(50.0)
224 (58.0)
McConnon, "usual care". Mean, 47.4 NS NS NS NR Weight (kg):
200723 Participants mean, 94.9 kg
randomized to the BMI:
usual care group mean, 34.4
were advised to Quality of Life
continue with their (Euro QoL):
usual approach to mean, 61.5
weight loss and Physical
were given a small Activity
amount of printed (Baecke):
information at mean, 6.7
baseline, reflecting
the type of
information
available within
primary care.
Internet group Mean, 48.1 NS NS NS NR Weight (kg):
mean, 97.5 kg
BMI:
mean, 34.35
Quality of Life
(EuroQoL):
mean, 70
Physical
Activity
(Baecke):
mean, 6.8
Tate, No counseling Mean, Minority, 6 (9) NS >16 yr, (49) NR F, 55 (82 ) Weight:
24
2006 49.9 mean, 88.3
SD, 8.3 (13.9)
body mass
index:
32.3 (3.7)
G‐304

Control Marital
internet
experiences:
4.7 (2.9)
Human email Mean, Minority, 8(13 ) NS >16 yr, (56) NR F, (53, 87) Weight:
counseling 49.7 mean, 89.0
SD, 11.4 (13.0)
body mass
index:
32.8 (3.4)
Internet
experiences:
4.1 (2.3)
Automated Mean, 47.9 Minority, 6(10) NS >16 yr, (59) NR F, 54 (84) Weight:
feedback SD, 9.8 mean, 89.0
(13.2)
body mass
index
32.7 (3.5)
Internet
experiences:
4.4 (2.2)
Williamson, Control and Mean, 13.2 NS NS NS NR Height:
25
2006 intervention SD, 1.4 mean, 160.0
adolescents cm
SD, 8.1
weight:
mean, 93.3 kg
SD, 22.5
BMI:
percentile 98.3
(2.5)
mean, 36.4
SD, 7.9
body fat DXA:
mean, 45.9
SD, 7.5
Control and Mean, 43.2 NS NS NS NR Height:
parents cm
SD, 6.9
G‐305

Control Marital
weight:
mean, 101.2
kg
SD, 18.4
BMI:
percentile not
reported
mean, 38.4
SD, 7.2
body fat DXA:
mean, 48.4
SD, 6.3
HIV
Gustafson, Control Mean, 34.5 White, non- Mean, 14.7yr Living alone Health insured,
26
1999 Hispanic, (86.7) mean, (80.5)
(31.9)
CHESS Mean 34.8 White, non- Mean, 14.3 yr Living alone Health insured,
Hispanic, (81.2) mean, (24) (75.8)
Pain
Borckardt, Distraction group Mean, 20.29 NS NS NS NR M, 26 NS
27
2007 SD, 2.38 F, 38
Computerized Mean, 20.52 NS NS NS NR M, 26 NS
Pain Management SD, 2.86 F, 30
Obesity
Morgan, One information 34 SD 11.6 NS NS Student: 14 Meas All M

2009 28 session + ured
Obesity Program booklet Non Acad by
Staff: 13 SEIFA
score
Acad Staff: 4
1,2-0
3,4-5
5,6-9
G‐306

Control Marital
7,8:11
9,10:3
SHED IT internet 37.5 SD 10.4 NS NS Student: 14 1,2-1 All M

program w/
information Non Acad 3,4-7
session and Staff: 14
program booklet 5,6-3
(the program Acad Staff: 6
7,8:11
facilitates self
monitoring and 9,10:2
daily diary to
which the
researchers
respond)
NR= Not Reported, NS= Not Significant, SD= Standard Deviation, SES= Socioeconomic Status, Yr = year, M = male, F = female, API = Asian/Pacific Islander, CBT =
computer-based training, kg = kilogram, BMI= Body Mass Index, QOL= Quality of Life, CHESS = Comprehensive Health Enhancement Support System
Reference List
111(3):368-77.
G‐307

Anxiety 2008; 25(7):555-8.
Psychol 2008.
45(3):483-96.
G‐308

2007; 7:206.
(Silver Spring) 2006; 14(7):1231-43.
9.
2004; 9(3):157-62.
G‐309

Evidence Table 37. All outcomes KQ 1d, impact of CHI applications on clinical outcomes
Measur
Control Measure at Measure e at Measure at Ratios
Author, Measure at time point at time time final time at time
year Outcome Intervention n BL 2 point 3 point 4 point points Significance
Alzheimer’s
Tarraga, Alzheimer’s Control 12 Mean, 20 24wks:
20061 Disease SD, 4.35 mean, 21.83
Assessment SD, 4.48
Scale-Cognitive IMIS,IPP, 15 Mean, 22.4 24wks:
ChEIs SD, 5.7 mean, 21.33
SD, 5.74
IPP, ChEIs 16 Mean, 24wks:
21.19 mean, 22.31
SD, 5.73 SD, 6.81
Arthritis
Lorig, Health distress Control 344 Mean, 2.37 6mos 1yr: p<0.001
20082 SD, 1.19 mean, 2.25
SD, 1.19
Online 307 Mean, 2.41 6mos 1yr:
intervention SD, 1.2 mean, 2
SD, 1.18
Activity Control 344 Mean, 3.22 6mos 1yr p<0.001
limitation SD, 0.903 mean, 3.29
SD, 0.885
Online 307 Mean, 3.17 6mos 1yr
SD, 0.962
Self reported Control 344 Mean, 6mos 1yr P< 0.004
global health 0.569 mean, 0.573
SD, 0.446 SD, 0.457
Online 307 Mean, 6mos 1yr
intervention 0.547 mean, 0.514
SD, 0.401 SD, 0.445
Pain Control 344 Mean, 6.37 6mos 1yr p<0.001
SD, 2.22 mean, 6.1
SD, 2.35
Online 307 6mos 1yr
SD, 2.53
Self efficacy Control 344 Mean, 4.96 6mos 1yr:
SD, 1.98 mean, 5.34
SD, 2.06
Online 307 Mean, 5.08 6mos 1yr:
G-310
Evidence Table 37. All outcomes KQ 1d, impact of CHI applications on clinical outcomes (continued)
Measur
SD, 2.09
Asthma
Jan, Symptom score Control 71 Mean, 0.05 Week 12:
3
2007 at nighttime median, 0 mean, 0.05;
SD, 0.13 median, 0;
SD, 0.19
Participants 82 Mean, 0.11 Week 12
received asthma median, 0 mean, 0.04
education and range, median, 0
with interactive 0.00-0.58 range,
asthma SD, 0.28 0.00-1027
monitoring SD, 0.17
system
Symptom score Control 71 Mean, 0.03 Week 12
at daytime median, 0 mean, 0.05
range, median, 0
0.00-0.58 range,
SD, 0.11 0.00-0.91
SD, 0.07
Participants 82 Mean, 0.14 Week 12
received asthma median, 0
education and range,
with interactive 0.00-1.17
asthma SD, 0.32
monitoring
system
Morning PEF Control 71 Mean, Week12: p<0.072
219.2 mean, 230.0
median, median,
212.7 229.6
range, range,
125.0-361.9 147.5-374.2
SD, 58.0 SD, 57.9
Participants 82 Mean,223.1 Week, 12 p <0.017
received asthma median, mean, 241.9
education and 214.6 median 220.0
with interactive range, range,
asthma 128.2-385.0 126.7-594.3
monitoring SD, 55.5 SD, 81.4
system
G-311
Measur
Night PEF Control 71 Mean, Week, 12 p<0.070
224.7 mean, 235.9
median, median,
213.8 232.1
range, range,
107.5-356.6 142.5-428.4
SD, 57.6 SD, 61.6
Participants 82 Mean, Week, 12 p<0.010
received asthma 232.5 mean, 255.6
education and median median,
with interactive 223.3 244.1
asthma range, range,
monitoring 141.4-389.4 123.3-655.5
system SD, 55.3 SD, 86.7
Back pain
Buhrman, CSQ- Control 29 Mean, 13.7 2 mos p<0.01
4
2004 Catastrophizing SD, 6.9 mean, 12.3
SD, 7.2
Cognitive 22 Mean, 13.6 2 mos
Behavior SD, 7.7 mean, 8.6
Intervention SD, 5.2
CSQ-Ability to Control 29 Mean, 2.6 2 mos p<0.05
decrease pain SD, 1.0 mean, 2.9
SD, .1.0
Cognitive 22 Mean, 3.0 2 mos
Behavior SD, 0.8 mean, 3.9
CSQ-Control Control 29 Mean, 2.9 2 mos: p<0.05
over pain SD, 1.1 mean, 2.9
SD, 1
Cognitive 22 Mean, 2.8 2 mos:
Behavior SD, 1 mean, 3.9
Breast cancer
Gustafson, Social/family Control 125 2 mos 5 mos:
20015 well being mean, 78.2 mean, 74.7
(quality of life)
Chess 121 2 mos 5 mos:
mean, 79.3 mean, 75.8
G-312
Measur
Emotional well- Control 125 2 mos 5 mos
being (quality of mean, 72.8 mean, 75.3
life) SD,
CHESS 121 2 mos 5 mos
mean, 73.9 mean, 76.3
Functional well- Control 125 2 mos 5 mos

being (quality of mean, 63.0 mean, 69.9
life)
mean, 62.2 mean, 70.4
Breast cancer Control 125 2 mos 5 mos

concerns mean, 63.3 mean, 64.7
(quality of life)
mean, 65.1 mean, 67.6
Gustafson, Quality of life Control 80 Mean, 0.18 9 mos: BL,
6
2008 SD, 0.53 mean, 0.11 .058
SD, 0.45 .039
.126
Time point 2,
.24
.004
.32
Final time
point,
.018
.021
.028
Internet 75 Mean, -0.02 9 mos: BL,
SD, 0.56 mean, 0.07 .84
SD, 0.45 .39
.69
Time point 2,
44
.77
.53
Final time
point, .33
G-313
Measur
.57
.48
CHESS 80 Mean, 0.02 9 mos: BL,
SD, 0.54 mean, 0.18 .029
SD, 0.54 .003
.007
Time point 2,
0.47
.027
.15
Final time
point,
.14
.14
.16
Maslin, Anxiety and Control 48 Score on 9 mos later p<0.001
19987 depression HAD
IVD shared 51 9 mos later
decision program
Katz, Porch Index of Control 15 Mean, 59.5 Week, 26
8
1997 Communicative SD, 16.2 mean, 61.3
Ability SD, 17.4
(percentiles) Computer 21 Mean, 57.3 Mean, 66.4 p<.01
Overall reading SD, 17.9 SD, 19.4
treatment
Computer 19 Mean, 51.9 Mean, 56.3 p<.01
stimulation SD, 20.3 SD, 20.9
Porch Index of Control 15 Mean, 55.6 Week, 26
Communicative SD, 16.0 mean, 58.1
Ability SD, 19.1
(percentiles) Computer 21 Mean, 54.4 Mean, 62.3 p<.01
Verbal reading SD,17.8 SD, 22.3
treatment
Computer 19 Mean, 49.3 Mean, 50.6
Western Control 15 Mean, 72.2 Week, 26
Aphasia Battery SD, 24.8 mean, 72.2
Aphasia SD, 23.7
"Quotient" Computer 21 Mean, 68.9 Mean, 73.6 p<.01
G-314
Measur
reading SD, 24.3 SD, 22.6
treatment
Western Control 15 Mean, 7.0 Week, 26
Aphasia Battery SD, 3.2 mean, 6.7
Aphasia SD, 3.4
"Repetition" Computer 21 Mean, 6.7 Mean, 7.3 p<.01
reading SD, 3.0 SD, 2.9
treatment
COPD
Nguyen, Score on CRQ Control 20 Score o n 3 mos 6 mos: BL,
9
2008 subscale for CRQ mean, 19.2 mean, 19.9 time point 2,
dyspnea with dyspnea SD, 5.8 SD, 6.2 improvement
ADLs subscale over time is
(score statistically
range from significant
5-35) rating p<0.001
5 activities final time
ion a Likert point,
scale of 1-7 improvement
points. over time is
mean, 15.9 statistically
SD, 5.4 significant
p<0.001
Electronic 19 Mean, 18.8 3 mos 6 mos: BL,
dyspnea self SD, 6.2 mean, 22.3 mean, 21.3 time point 2,
management SD, 4.6 SD, 6 significant
program change from
baseline. No
significant
difference
between
intervention
& control
groups.
final time
point,
G-315
Measur
significant
change from
baseline. NO
difference
between
control &
intervention
groups.
p,0.14
Headache
Trautman, Frequency Control 8 Number of Post- 6 mos follow-
10
2008 headaches treatment up
mean, 13.8 mean, 12.3
SD, 10.1 SD, 8.6
CBT 8 Number of Post- 6 mos follow- <0.05
headaches treatment up:
mean, 15.2 mean, 8.1 mean, 8
SD, 10.9 SD, 8 SD, 7.8
Duration Control 8 Duration of post- 6 mos follow-
headaches: treatment up
mean, 6 mean, 5.1
SD, 5-24 SD, 2-23
CBT 8 Duration of Post- 6 mos follow- >0.05
headaches: treatment up
mean, 3.8 mean, 3.5 mean, 3.3
SD, 2-24 SD, 2.24 SD, 1.23
Intensity 8 Intensity of Post- 6 mos follow-
Headaches treatment up
mean, 5.8 mean, 5
SD, 1.5 SD, 1.3
CBT 8 Intensity of Post- 6 mos follow- >0.05
Headaches treatment up
mean, 4.7 mean, 4.7 mean, 4.2
SD, 0.8 SD, 1.3 SD, 1.9
Pain 8 PCS-C Post- 6 mos follow-
catastrophizing mean, 36.4 treatment up
SD, 9.7 mean, 37.3
SD, 7.9
CBT 8 Mean, 30 Post- 6 mos follow- <0.05
SD, 5.9 treatment up
G-316
Measur
mean, 28.3
SD, 5.8
Mental Health (Depression/Anxiety)
Christensen, Center for 159 Mean score 6 wks:
200411 Epidemiologic point mean, 1.1
depression improveme SD, 8.4
scale nt over
baseline
mean, 21.6
SD, 11.1
Blue Pages: 136 Mean score 6 wks
Computer based point mean, 3.9
psycho education improveme SD, 9.1
website offering nt over
information about baseline
depression mean, 21.1
SD, 10.4
Mood GYM: 136 Mean score 6 wks
Computer based point mean, 4.2
Cognitive improveme SD, 9.1
Behavior therapy nt over
baseline
mean, 21.8
SD, 10.5
Hasson, Biological Control 156 Changes in 6 mos follow Time*group
12
2005 marker: self rated up effect, .04
dehydroeoiando measures
sterone and
sulphate biological
markers
covariated
for baseline
scores
Web-based 121 Changes in 6 mos follow- Time*group
stress self rated up effect, .04
Management measures
system and
biological
markers
covariated
G-317
Measur
for baseline
scores
Nero peptide Control 156 Changes in 6 mos Time*group
self rated Follow- up effect, .002
measures
and
biological
markers
covariated
for baseline
scores
Web-based 121 Changes in 6 mos Time*group
stress self rated follow up effect, .002
management measures
system and
biological
markers
covariated
for baseline
scores
Chromogranin Control 156 Changes in 6 mos Time*group
self rated follow up effect, .001
measures
and
biological
markers
covariated
for baseline
scores
Web-based 121 Changes in 6 mos follow Time*group
stress self rated up effect, .001
management measures
system and
biological
markers
covariated
for baseline
scores
Kerr, CES-D score Control 146 CES-D 6 mos 12 mos
200813 score (10 or
G-318
Measur
greater
probable
depression)
mean, 7.5
SD, 4.43
PACEi 146 CESD 6 mos 12 mos BL,
score (10 or time point 2,
greater non
probable significant
depression) final time
mean, 7.38 point, non
SD, 4.96 significant
March, Clinical severity Control Mean, 5.83 Post at 6 mos
14
2008 rating SD, 0.6 treatment at
10 wks
mean, 5.14
SD, 1.43
Web based Mean, 6.07 Post at 6 mos BL,
intervention SD, 0.58 treatment at mean, 2.32 time point 2,
10 wks SD, 1.78 significant
mean, 4.3 difference of
vs. control
time point 3,
significant
diff of post
treatment
( point 2) vs.
Follow up
( point 3)
Children global Control Mean, Post at 6 mos

assessment 51.72 treatment at
score SD, 5.24 10 wks
mean,
54.93
SD, 8.91
Web based Mean, Post at 6 mos BL,
intervention 50.87 treatment at mean, time point 2,
SD, 3.95 10 wks 73.67 significant
G-319
Measur
mean, SD, 9.14 intervention
61.73 vs. control
SD, 8.71 time point 3,
sig. post
treatment vs.
follow up)
Does not meet Control 1 10 wks: 6 mos Time point 2,
criteria for any 3.4 0.09
anxiety disorder (intervention
vs. control)
Web based 17 10 wks: 6 mos:
intervention 16.7 60.7
Orbach, Test Anxiety Control 28 Mean, Post

15
2007 Inventory 59.18 treatment:
SD, 12.20 mean, 54.25
SD, 11.31
Cognitive 30 Mean, Post
Behavior 58.14 treatment:
Therapy group SD, 8.43 mean, 47.31
(CBT) SD, 9.49
Anxiety Control 28 Mean, Post
Hierarchy 12.73 treatment
Questionnaire SD, 1.66 mean, 12.62
SD, 2.04
Behavior 12.64 treatment
(CBT) SD, 3.45
AH tests Control 28 AH test Post
(perceptual and mean, treatment
numerical) 48.74 mean, 51.58
SD, 8.18 SD, 9.82
Behavior 44.55 treatment
(CBT) SD, 13.3
General Self- Control 28 Mean, Post
Efficacy Scale 53.46 treatment:
SD, 13.09 mean, 44.69
G-320
Measur
SD, 7.67
Behavior 57.97 treatment:
(CBT) SD, 7.67
Proudfoot, BDI(beck Control 42 Mean, 6mos
200316 depression 24.08 mean, 16.07
inventory) SD, 9.78 SD, 13.06
beating the blues 44 Mean, 6mos
25.38 mean, 9.61
SD, 11.05 SD, 10.06
BAI (beck Control 38 Mean, 6mos
anxiety 19.39 mean, 11.32
inventory) SD, 9.72 SD, 9.61
beating the blues 40 Mean, 6mos
18.33 mean, 8.73
SD, 9.61 SD, 7.66
WSA (work and Control 42 Mean, 6mos
social 18.46 mean, 12.1
adjustment SD, 8.25 SD, 10.11
scale) Beating the blues 45 Mean, 6mos
19.89 mean, 9.11
SD, 9.29 SD, 8.97
Spek, Treatment Control 58 Mean, 12mos:
200817 response after 1 18.31 mean, 12.88
yr SD, 7.88 SD, 10.1
treatment Group CBT 66 Mean, 12mos:
17.99 mean, 12.14
SD, 9.39 SD, 8.76
Internet based 58 Mean, 12mos:
intervention 19.07 mean, 10.45
SD, 7.04 SD, 8.05
Diabetes
Homko, Insulin therapy Control 25 4(n,1)
200718 Telemedicine 28 31
(n,10)
FBS Control 25 FBS mg/dl 37 wks
gestation
mean, 88.6
SD, 9.5
G-321
Measur
Telemedicine 32 37 wks Non
gestation significant
mean, 90.8
SD, 11.8
A1c at time of Control 25 A1c at 37 wks
delivery delivery (%) gestation
mean, 6.2
SD, 2.2
Telemedicine 32 37 wks Non
gestation significant
mean, 6.1
SD, 0.8
Tjam, 200619 A1C (%) Control 19 Mean, 6.8 3 mos 12 mos:
SD, 1.0 mean, 6.8 mean,
SD, 1 SD,
Individuals with 34 Mean, 6.7 3 mos 12 mos:
interactive SD, 1 mean, 6.5 mean,
internet program SD, 1 SD,
FBG (MMOL/L) Control 8 Mean, 7.98 3 mos 6 mos 12 mos
SD, 2.07 mean, 7.71
SD, 2.14
Individuals with 17 Mean, 8.51 3 mos 6 mos 12 mos
interactive SD, 2.46 mean, 8.02
internet program SD, 2.17
TC (MMOL/L Control 9 mean, 5.38 3 mos 6 mos 12 mos
SD, 1.13 mean, 4.6
SD, 0.9
Individuals with 16 Mean, 4.98 3 mos 6 mos 12 mos
interactive SD, 1.11 mean, 5.15
TG (MMOL/L) Control 14 Mean, -0.09 3 mos 6 mos 12 mos
SD, 0.12 mean, 2.1
SD, 0.76
Individuals with 24 3 mos 6 mos 12 mos
interactive mean, 1.9
Wise, 1986 20 IDDM Patients
Diabetes Knowledge Index Assessment of 24 Knowledge 82 SE 2 Ns
(KAP KAP only Score: 79 SE
Questionnaire) 2
G-322
Measur
4—6mo Assessment + 22 78 SE 2 83 SE 3 significant
Feedback
Interactive
computer
NIDDM Patients NIDDM
Patients
Knowledge Index Assessment of 22 Knowledge UNS Ns
(KAP KAP only UNS
Questionnaire) Assessment + 24 64 SE 2 73 SE 2 significant
4—6mo
Feedback
Interactive
computer
IDDM Patients IDDM Patients
Knowledge Index Control 20 HBA1c: 8.9% 8.8% NS
(KAP Assessment of 24 9.1 SE 0.2 8.4 SE 0.1 Significant
Questionnaire) KAP only
4—6mo
Feedback
Interactive
computer
NIDDM Patients NIDDM
Patients
Knowledge Index Control 21 HBA1c: 8.7% 8.5% NS
(KAP Assessment of 22 9.6 SE 0.4 8.8 SE 0.3 Significant
Questionnaire) KAP only
4—6mo Assessment + 24 9.2 SE 0.4 7.9 SE 0.4 significant
Feedback
Interactive
computer
Diet/exercise/physical activity not obesity
Adachi, % weight loss Control 50 1 mos 3 mos 7 mos BL,
21
2007 (Group B) mean, -0.05 mean, -1.6 mean, -2.2 time point 2,
SD, 1.4 SD, 2.3 SD, 3.5 0.01
time point 3,
0.01
final time
point, 0.05
G-323
Measur
Computer 36 1 mos 3 mos 7 mos BL,
tailored program mean, -1.8 mean, -3.6 mean, 4.7 time point 2,
with 6-mos SD, 1.9 SD, 3.3 SD, 4.5 0.01
weight and time point 3,
targeted 0.01
behavior’s self- final time
monitoring, point, 0.05
(Group KM)
Computer 44 1 mos 3 mos 7 mos BL,
tailored program mean, -1.5 mean, -2.6 mean, -3.3 time point 2,
only, SD, 1.6 SD, 2.8 SD, 4.3 0.01
(Group K) time point 3,
0.01
final time
point, 0.01
untailored self- 53 1 mos 3 mos 7 mos BL,
help booklet with mean, -0.08 mean, -2 mean, -2.6 time point 2,
7-mos self- SD, 1.3 SD, 2.5 SD, 3.4 0.01
monitoring of time point 3,
weight and 0.01
walking, time point 4,
(Group BM) final time
point, 0.05
Hunter, Body weight Control 222 Mean, 86.6 6mos:
200822 (kg) SD, 14.7 mean, 87.4
SD, 14.7
BIT 224 Mean, 87.4 6mos:
SD, 15.6 mean, 85.5
SD, 15.8
McConnon, Loss of 5% or Control 77 6 mos 12 mos:
23
2007 more body 18
weight (12 mos)
internet group 54 6 mos 12 mos:
22
Tate, Weight loss Control 59 3mos 6 mos

200624 mean, -2.8 mean, -2.6
SD, 3.5 SD, 5.7
Tailored 44 3mos 6mos
Computer- mean, -5.3 mean, -4.9
G-324
Measur
Automated SD, 4.2 SD, 5.9
Feedback
Human Email 52 3mos 6mos
Counseling (HC) mean, -6.1 mean, -7.3
SD, 3.9 SD, 6.2
Williamson, Body weight Control 50 24 mos:
200625 (kg) mean
A,6.3
P,-0.06
SD,
A,1.6
P,0.89
Interactive 47 24 mos:
Nutrition mean
education A: 4.4
program and P: -1.1
internet SD
counseling A: 1.7
behavioral P: 0.91
therapy for the
intervention
group
BMI Control 50 6 mos 12 mos 18 mos 24 mos
mean
A:1.2,
P:0.04
SD
A:.65,
P;.34
Interactive 47 Mean, 6 mos 12 mos 18 mos 24 mos
Nutrition A:36.4, mean
education P;38.4 A:0.73,
program and SD P:-0.55
internet A:7.9, SD
counseling P:7.2 A:.66,
behavioral P:0.34
therapy for the
intervention
group
Weight loss Control 50 6 mos 12 mos 18 mos 24 mos
G-325
Measur
behavior (body mean
fat %) A:0.84,
P:0.51
SD,
A:0.72,
P:0.46
Interactive 47 Mean 6 mos 12 mos 18 mos 24 mos
Nutrition A:45.9, mean,
education P:48.4 A:-.08,
program and SD P:0.36
internet A:7.5 SD
counseling P:6.3 A:0.71,
behavioral P:0.46
therapy for the
intervention
group
BMI (percentile) Control 50 BMI 6 mos 12 mos 18 mos 24 mos
mean,
A:-0.001
SD,
A:0.003
Interactive 47 6 mos 12 mos 18 mos 24 mos
Nutrition mean
education A:-0.004
program and SD
internet A:0.003
counseling
behavioral
therapy for the
intervention
group
HIV
Gustafson, Active life Control 97 1.37(22) p<0.034
199926 CHESS 107 1.66(27)
Social support Control 97 4.24(24) p<0.017
CHESS 107 4.47(27)
Participation in Control 97 3.64(23) p<0.020
health care CHESS 107 4.15(24)
Pain
Borckardt, Cold Pressor Control 64 Seconds Immediate
G-326
Measur
200727 Tolerance post:
mean, 73.25
CACIS 56 Seconds Immediate

post:
mean, 86.25
Obesity
Morgan, 2009 Change in body Prog info + 31 Loss of All
28 Weight: −3.0
Obesity wt. 3m Booklet gp differences
(−4.5, −1.4) statistically
KG
significant
SHED IT group 34 Loss of
Weight: −4.8
(−6.4, −3.3)
KG
Change in body Prog info + 31 Loss of
wt. 6m Booklet gp Weight: −3.5
(−5.5, −1.4)
SHED IT group 34 Loss of
Weight: −5.3
(−7.3, −3.3)
Waist Prog info + 31 LOSS: −4.4
circumference Booklet gp (−6.3, −2.5)
(cm) 3m CM
SHED IT group 34 LOSS: −5.2
(−7.1, −3.4)
CM
Waist Prog info + 31 −5.6 (−7.7,
circumference Booklet gp −3.5) CM
(cm) 6m
SHED IT group 34 −7.0 (−9.1,
−4.9) CM
BMI (kg/m2) 3m Prog info + 31 −0.9 (−1.4,
Booklet gp −0.5) KG/M^2
SHED IT group 34 −1.5 (−2.0,
−1.0) KG/M^2
BMI (kg/m2) 6m Prog info + 31 −1.1 (1.7,
Booklet gp −0.5)
SHED IT group 34 −1.6 (−2.2,
−1.0)
pressure 3m Booklet gp MM HG
SHED IT group 34 −6 (−10, −1)
G-327
Measur
MM HG
SHED IT group 34 −10 (−14, −7)
pressure 3m Booklet gp MM HG
SHED IT group 34 −4 (−8, −1)
MM HG
SHED IT group 34 −6 (−11, −1)
Resting heart rate Prog info + 31 −7 (−11, −3)
3m Booklet gp BPM
SHED IT group 34 −9 (−12, −5)
BPM
Resting heart rate Prog info + 31 −7 (−12, −3)
6m Booklet gp BPM
SHED IT group 34 −6 (−11, −2)
BPM
Physical activity Prog info + 31 Went Up by:
(mean steps/day) Booklet gp 976 (−12,
3m 1,965)
STEPS/DAY
SHED IT group 34 Went Up by:
1,184 (234,
2,133)
STEP/DAY
Physical activity Prog info + 31 Went Up by:
(mean steps/day) Booklet gp 1,302 (241,
6m 2,363)
SHED IT group 34 Went Up by:
938 (−90,
1,966)
Energy intake Prog info + 31 Went down
(kJ/day) 3m Booklet gp by: −2,068
(−3,089,
−1,047)
KJ/DAY
SHED IT group 34 Went down
by: −3,195
(−4,159,
−2,230)
KJ/DAY
G-328
Measur
Energy intake Prog info + 31 Went down
(kJ/day) 6m Booklet gp by: −1,881
(−3,087,
−676)
KJ/DAY
SHED IT group 34 Went down
by: −3,642
(−4,764,
−2,521)
KJ/DAY
BL = baseline, SD = standard deviation, , mos = months, wks = weeks, CHESS = Comprehensive Health Enhancement Support System, CES-D = Center for Epidemiologic
Studies Depression Scale, CBT = cognitive behavior therapy, CACIS = Computer-Assisted Cognitive/Imagery System, FBG = Fasting blood glucose,
TC = total cholesterol, TG = triglycerides, A1c = glycosylat ed hemoglobin
Reference List
111(3):368-77.
G-329
Anxiety 2008; 25(7):555-8.
Psychol 2008.
45(3):483-96.
2007; 7:206.
G-330
(Silver Spring) 2006; 14(7):1231-43.
9.
2004; 9(3):157-62.
G-331
Evidence table 38. Description of RCTs addressing the impact of CHI applications on economic outcomes (KQ1e)
Year data
Asthma
Joseph, Individual Interactive Remote NS 9-11 grade, NS Generic Tailored website 2.5
20071 interested consumer location: Current asthma asthma
in their own website school website
health
Jones, Individual Interactive Clinician December Breast, Receiving Booklet General 1.5
19992 interested consumer office 1996- laryngeal, palliative information computer
in their own website December prostate, treatment, information
health care 1997/NS Cervical cancer no knowledge of
patients receiving diagnosis, Personalized
care at oncology visual or mental computer
center handicap , information
severe pain
Obesity
McConnon, Individual Interactive Home/ NS 18 - 65 yr, NS Usual care Internet group 1
20073 interested consumer residence BMI 30 or more,
in their own website able to access
time a week,
able to read and
write English
NS = Not specified, BMI = Body mass index, Yr = year
Reference List
Crit Care Med 2007; 175(9):888-95.
2. Jones R, Pearson J, McGregor S et al. Randomised trial of personalised computer based information for cancer patients. BMJ 1999; 319(7219):1241-7.
3. McConnon A, Kirk SF, Cockroft JE et al. The Internet for weight control in an obese sample: results of a randomised controlled trial. BMC Health Serv Res
2007; 7:206.
G-332
Evidence table 39. Description of consumer characteristics in studies addressing the impact of CHI applications on economic outcomes (KQ1e)
Author, Control Race, Education,

year Intervention Age n(%) Income n(%) SES Gender, n (%) Other characteristics
Asthma
Joseph, Generic asthma website Mean, 15.3 NS NA High school NS F, 199 (63.4) Smoking status:
20071 Tailored website SD, 1 students > 2 per day, 15 (5.2)
Cancer: breast, lung, prostate and esophageal
Jones, Booklet information No baseline participant characteristics were provided
2
1999 General computer information
Personal computer information
Obesity
McConnon, "usual care". Participants Mean, 47.4 NS NS NS NS NS Weight (kg):
3
2007 randomized to the usual care mean, 94.9 kg
group were advised to continue BMI:
with their usual approach to mean, 34.4
weight loss and were given a Quality of Life (Euro
small amount of printed QoL):
information at baseline, reflecting mean, 61.5
the type of information available Physical Activity
within primary care. (Baecke):
mean, 6.7
Internet group Mean, 48.1 Weight (kg):
mean, 97.5 kg
BMI:
mean, 34.35
Quality of Life
(EuroQoL):
mean, 70
Physical Activity
(Baecke):
mean, 6.8
* Only “all participants” data was provided in this paper with a notation that there were no differences between the treatment and control groups
NS = not specified, SD = standard deviation, BMI = body mass index, kg = kilogram, SES= Socioeconomic Status, NA = Not Applicable, QoL = quality of Life
Reference List
Crit Care Med 2007; 175(9):888-95.
2007; 7:206.
G-333
Evidence table 4. Outcomes in studies addressing Key Question 1a, impact of CHI applications on health care processes
Control
Author, Measure at final time ratios at
Year Outcome Intervention n Measure at BL point time points Significance
Asthma
Bartholomew, Control: Usual care 63
1
2000 Intervention 70
Watch, Discover,
Think and Act (An
Interactive multimedia
application on CD-
ROM)
Guendelman, Health and Control: participants 66 Limitation in activity Limitation in activity .03
20022 quality of life used an asthma diary No:19 (28) No:32 (53)
and process Yes: 49 (72) Yes: 28(47)
evaluation Peak flow Peak flow measurement
measurement ever: No No 27(40)
12 (18) Yes 26 (38)
Yes 20 (29) Missing data 36 (53)
Missing data: 36 (53) Coughing
Coughing No21(35)
No7(10) Yes39(65)
Yes 61(90) Trouble sleeping
Trouble sleeping No
No Yes
Yes
Intervention: Health 68 Limitation in activity Limitation in activity No: 0.52 .03
Buddy(is a personal No: 22 (33) 42 (68)
and interactive Yes:44 (67) Yes:20(32)
communication Peak flow Peak flow measurement
device) measurement ever ever
No 14 (21) No 38 (58)
Yes 22(33) Yes 19(29)
Missing data 30 (45) Missing data 09 (14)
Coughing Coughing
No10(15) No23(37)
Yes56(85) Yes39(63)
Trouble sleeping Trouble sleeping
No No
Yes Yes
Jan, Monitoring Control 71 Mean, 85.6 12 week
3
2007 adherence mean, 93.5
G-21
Evidence table 4. Outcomes in studies addressing Key Question 1a, impact of CHI applications on health care processes (continued)
Control
Asthma education 82 Mean, 83.5 12 week
and an interactive mean, 99.7
asthma monitoring
system
Therapeutic Control 15
adherence Asthma education 23
and an interactive
asthma monitoring
system
Adherence to Control 71 Mean, 93.2 12 week
daily diary mean, 53.4
entry Asthma education 82 Mean, 96 12 week
and an interactive mean, 82.5
asthma monitoring
system
Therapeutic Control 71 Mean, 80.3 12 week
adherence: mean, 93.4
DPI or MDI Asthma education 82 Mean, 82.1 12 week
plus spacer and an interactive mean, 96.5
technique asthma monitoring
score system
Peak flow Control 97 Mean, 82.3 12 week
meter mean, 42.1
technique Asthma education 99 Mean, 83.5 12 week
score and an interactive mean, 63.2
asthma monitoring
system
Krishna, Days of quick Control 44 Mean, 90.7 12 months
4
2003 relief medicine SD, 114.8 mean, 41
SD, 82
Internet-enabled 42 12 months
asthma education mean, 26.3
program SD, 56.6
Urgent Control 44 Mean, 6.4 12 months
physician visit SD, 10.5 mean, 1.3
SD, 2.2
Internet-enabled 42 Mean, 6.6 12 months
asthma education SD, 10.5 mean, 0.8
program SD, 1.5
G-22
Control
Emergency Control 44 Mean, 1.2 12 months
room visit SD, 2.8 mean, 0.6
SD, 1.1
Internet-enabled 42 Mean, 2 12 months
program SD, 0.4
Daily dose of Control 44 Mean, 350.53 12 months
inhaled SD, 649.61 mean, 753.88
corticosteroids SD, 706.94
Internet-enabled 42 Mean, 353.09 12 months
program SD, 569.13
Chewning, Oral Control NA Initial visit 1 yr NS
5
1999 contraceptive mean, 11.26 mean, 6.38
efficacy SD, 15.93 SD, 13.45
Chicago Computerized NA Initial visit 1 yr
decision aid mean, 4.59 mean, 5.66
SD, 9.2 SD, 8.45
Oral Control NA Initial visit 1 yr NS
contraceptive mean, 4.8 mean, 4.83
efficacy SD, 5.58 SD, 9.15
Madison Computerized NA Initial visit 1 yr
decision aid mean, 2.09 mean, 4
SD, 2.2 SD, 8.26
NA= Not applicable, NS= Not Significant, Yr = year, BL = baseline, SD = standard deviation
G-23
Reference List
1. Bartholomew LK, Gold RS, Parcel GS et al. Watch, Discover, Think, and Act: Evaluation of computer-assisted instruction to improve asthma self-
2. Guendelman S, Meade K, Benson M, Chen YQ, Samuels S. Improving asthma outcomes and self-management behaviors of inner-city children: A
5. Chewning B, Mosena P, Wilson D et al. Evaluation of a computerized contraceptive decision aid for adolescent patients. Patient Educ Couns 1999;
38(3):227-39.
G-24
Evidence table 40. All outcomes in studies addressing the impact of CHI applications on economic outcomes (KQ1e)
Control
Author,
year Outcome Intervention n Measure at BL Measure at final time point, define
Asthma
Joseph, 20071 Cost of program delivery Control 152 No baseline measure 12 months:
of cost no cost estimate for control group
Treatment 162 12 months:

cost of referral coordinator,
$6.66/per treatment student
Cancer: breast cervical prostate and laryngeal cancer
Jones, 19992 Cost of the computer Control: books alone 162 No baseline measure
information system—Manual of cost
extraction of Patient data General computer information 143
Tailored computer information 162 9x the cost of a general information system

Cost of the computer Control: books alone 162
information system—use of General computer information 143
electronic patient record Tailored computer information 162 No difference in cost between general and
tailored systems
Materials cost Control: books alone 162 £7/patient
General computer information 143 £2.8/patient
Tailored computer information 162 NS
Obesity
McConnon, Total costs Control 110 No baseline costs £276.12
20073 Website (internet group) 111 reported £992.40*
Incremental cost- Control 110 NS
effectiveness Website (internet group) 111 £39,248/QALY
*Difference in cost is due to the cost of developing the website; when this fixed cost was removes; total costs were lower in the intervention group (actual results not presented).
BL = baseline, NS = not specified, QALY = quality-adjusted life year, $ = United States Dollars
Reference List
Crit Care Med 2007; 175(9):888-95.
2007; 7:206.
G‐334

Evidence Table 41. Description of all study designs addressing barriers KQ 2
Author, Barrier TARGET Year/ Inclusion / Control/

year Design type Condition Consumer Application Location duration Exclusion Interventions
Simon, Survey/ User level Breast Individuals Interactive Clinician 2007/ Female No control
1
2008 interview cancer interested in their electronic office NS scheduled to get group/
own health care , tool a mammogram
women getting Survey
mammogram respondents
Cimino, Survey System Usage Individuals Access to NS 1999/ No control
2
2001 (cross- level study of interested in their patient NS group
sectional) general own health care records with
User level med group tailored
feedback
Keselman, Survey System Multiple Individuals Interactive NS 2006 Who viewed their No control
3
2007 level condition interested in their consumer paper or group
own health care website electronic health
User level records within
the past year
Shaw, Applicability User level Breast Individuals Interactive NS May2001 Women No control
20084 of a C- cancer interested in their consumer participants were group/
SHIP own health care website at or below 250% CHESS users
model to of the federal
discern why poverty level
people with resided within
cancer one of 56 rural
seek online Wisconsin
information counties (as
to cope defined by the
with Office of
disease Management and
Budget criteria)
within one year
of diagnosis of
breast cancer or
had metastatic
breast cancer
not homeless
able to read and
understand an
informed consent
letter
Nijland, System Design of Individuals Interactive Home/ NS At least 18 yr old No control
5
2008 level the interested in their consumer residence Dutch speaking group
Internet- own health care, website workplace had experience
User Level based non-medical with using one of
G-335
Evidence Table 41. Description of all study designs addressing barriers KQ 2 (continued)

applications caregiver the Internet
for self-care based
applications
Morak, Pilot User level Obesity Individuals Interactive Clinician NS No control
20086 interested in their consumer office group
own health care website
Steele, RCT System Diet/exercis Individuals Interactive Local 12 weeks More than 18 No control
20077 level e/ physical interested in their consumer community years old group/
activity own health care website of Rock Both male and Face to face
NOT Hampton, female n:52,
obesity Queensland Functionally
mobile more than Both face to
10 min face and
Inactive internet n:51,
Access to
internet Internet
Singed informed only:56
consent.
Less than 18
years
Functionally
immobile more
than 10 min
Active
No access to
internet
Did not signed
informed consent
Wangberg, RCT User level Diabetes Individuals Interactive NS NS 17-67 yr Low self-
8
2008 interested in their consumer Type I or II efficacy
own health care website diabetes
access to the
internet
Lober, Survey User level Computer Individuals Patient kiosk Home/ 8 months Resident at No control
9
2006 literacy interested in their residence publicly group
Computer own health care Remote subsidized
anxiety location, housing project
Cognitive common
impairment computer
Health area
literacy
G-336

Physical
impairment
Stock, Within- System Usability Individuals Palmtop NS NS 18-54 yr No control

10
2006 subject level interested in their computer both male and group/
design own health care female all subjects
intellectual
disabilities vision,
hearing and
motor skills to
interact with
palmtop
Mangunkusumo, RCT System Diet/exercis Individuals Internet site Remote NS
11
2007 level e/ physical interested in their location, at a
activity own health care, secondary
NOT student--with school
obesity parental consent
Ferney, Qualitative; System Diet/exercis Individuals Interactive Unspecified NS No control
200612 semi- level e/ physical interested in their consumer location of a group
structured activity own health care website, study group
interview NOT
obesity
Temesgen, Survey System HIV/AIDS Individuals Interactive Home/ 6 months HIV positive No control/
200613 level interested in their consumer residence Use of CHESS
User level own health care website, intervention
Owen, Survey User level Breast Individuals Interactive Clinician 1999/ NS Appointment at No control
200414 cancer interested in their consumer office Dept of group
own health care website, Hematology/Onc
ology at the
University of
Alabama at
Birmingham
Comprehensive
Cancer Center
Histologicaly
confirmed breast
cancer
G-337

Lahdenpera, Interviewed User level Hypertensi Individuals Personal Clinician Between 16-64 yr, No control
15
2000 before use on interested in their monitoring office summer Hypertension for group/
of IT own health care device 1997 and one year or less Study group
application Autumn Hypertension
1998 medication for
one year or less
or none
Three successive
blood pressure
readings
exceeded 140/90
mm Hg
Weber, User level DSM-III-R Individuals Interactive NS NS Mixed DSM-III-R Healthy group/
16
1998 psychiatric interested in their self psychiatric Patients
disorders own health care assessment disorders and
healthy
volunteers
hospitalized for
psych disorders
Jenkinson, Qualitative User level Prostate Individuals Interactive Clinician NS Newly diagnosed
17
1998 study cancer interested in their consumer office (1-12 months)
own health care website, English speaking
localized prostate
cancer
Paperny, Survey User level HIV/AIDS Individuals Interactive Clinician NS "Teens" No control
199718 after use and interested in their consumer office group/
substance own health care, website, Public Public School,
abuse Youth at risk Health Fairs, Medical
school, Clinics,
detention
facility, Detainees and
runaway runaways
shelter and a
youth
corrections
facility
G-338

McTavish, Qualitative User level Breast Individuals Interactive Home/ 1993 and Stage 1 or 2 No control
19
1994 cancer interested in their consumer residence 1994 breast cancer group/
own health care website Users of
CHESS
program in
Chicago Pilot
Study
Cavan, Pilot trial User level Diabetes Individuals Interactive Home/ NS 29-61 yr No control
20
2003 interested in their consumer residence group/
own health care website Patient with
type 1 diabetes
Feil, A study in a User level Diabetes Individuals Interactive Home/ 1 yr 40-75 yr No control
200021 primary interested in their consumer residence Female group
care setting own health care website Have current
internet access
Type 2 diabetes
Healthy
Diagnosed at
least 1 year
Not moving or
staying in the
area
Can read or write
English
Under 40 or over
75 years
Male
Current internet
access
No type 2
diabetes
Incapacitated or
too ill
Diagnosed less
than 1 year
Moving or not in
area
Can’t read or
write English
G-339

Zeman, A study on System Mental NS Disease Clinician NS No control
22
2006 PDA level health specific office group
implementa sensor
tion User level
problem
Bryce, Combinatio User level Diabetes Individuals Web-Based Between participate were
200823 n of interested in their Portal for August over the age of
qualitative System own health care Managemen 2004 and 21years,
methods level t of Diabetes January Were English-
and 2005 speaking,
quantitative received a
methods diagnosis of type
1 or type
2 diabetes
mellitus,
Agreed to attend
a focus group
session and
complete a
survey
Leslie, RCT User level Physical Individuals Interactive NS
200524 Activity/ interested in their consumer
Diet/ own health care website
Obesity
Ferrer-Roca, mobile User level Diabetes Individuals mobile Home/ 8 months All patients had a
200425 phone text interested in their phone text residence diagnosis of
messaging System own health care messaging diabetes and
(short level were aged 18–75
message years.
service; Patients had to
SMS) for have their own
diabetes personal mobile
manageme phone,
nt or have access
to one belonging
to a relative.
Lenert, Pilot User level Smoking Individuals Interactive NS
200326 Cessation interested in their consumer
own health care website
G-340

Kressig, To User level Physical Individuals Interactive participants if
27
2002 determine if Activity/ interested in their consumer they were 60
older Diet/ own health care website
years of age and
adults are Obesity
capable older and
and willing without medical
to interact contraindication
with a for exercise.
computeriz
ed
exercise
promotion
interface
Brug, RCT User level Physical Individuals computer- individualized
199828 Activity/ interested in their generated computer-
Diet/ own health care tailored generated
Obesity poster nutrition
information
Boberg, Survey User level HIV/AIDS Individuals Interactive Home/ people living with CHESS
199529 interested in their consumer residence AIDS/HIV
own health care website infection
(CHESS)
Shaw, RCT System All cancer Individuals Physician January Eligible patients Interactive
200130 level interested in their office 1, 1996 were 18 to 80 Computer-
own health care to August years old, spoke assisted
1, 1997 English, had Instruction
never had a Program
colonoscopy, and
were not
scheduled to
receive.
Strecher, RCT User level Smoking Individuals computer- Home/ During Eligible patients Generic health
199431 cessation interested in their generated residence March were 40 to 65 letter/
own health care tailored letter and April years old Tailored health
1990 Had seen a letter
family physician
in the practice no
more than 6
months before
being
interviewed,
had telephones
G-341

with available
and working
numbers
NS = not specified, CHESS = Comprehensive Health Enhancement Support System, yr = year, RCT = randomized controlled trial, CHESS = Comprehensive Health Enhancement
Support System
Reference List
1. Simon C, Acheson L, Burant C et al. Patient interest in recording family histories of cancer via the Internet. Genet Med 2008; 10(12):895-902.
2. Cimino JJ, Patel VL, Kushniruk AW. What do patients do with access to their medical records? Stud Health Technol Inform 2001; 84(Pt 2):1440-4.
3. Keselman A, Slaughter L, Smith CA et al. Towards consumer-friendly PHRs: patients' experience with reviewing their health records. AMIA Annu Symp
Proc 2007; 399-403.
4. Shaw BR, Dubenske LL, Han JY et al. Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application
of the Cognitive-Social Health Information Processing (C-SHIP) model. J Health Commun 2008; 13(4):389-408.
5. Nijland N, van Gemert-Pijnen J, Boer H, Steehouder MF, Seydel ER. Evaluation of internet-based technology for supporting self-care: problems
encountered by patients and caregivers when using self-care applications. J Med Internet Res 2008; 10(2):e13.
6. Morak J, Schindler K, Goerzer E et al. A pilot study of mobile phone-based therapy for obese patients. J Telemed Telecare 2008; 14(3):147-9.
7. Steele R, Mummery KW, Dwyer T. Development and process evaluation of an internet-based physical activity behaviour change program. Patient Educ
Couns 2007; 67(1-2):127-36.
8. Wangberg SC. An Internet-based diabetes self-care intervention tailored to self-efficacy. Health Educ Res 2008; 23(1):170-9.
9. Lober WB, Zierler B, Herbaugh A et al. Barriers to the use of a personal health record by an elderly population. AMIA Annu Symp Proc 2006; 514-8.
10. Stock SE, Davies DK, Davies KR, Wehmeyer ML. Evaluation of an application for making palmtop computers accessible to individuals with intellectual
disabilities. J Intellect Dev Disabil 2006; 31(1):39-46.
11. Mangunkusumo R, Brug J, Duisterhout J, de Koning H, Raat H. Feasibility, acceptability, and quality of Internet-administered adolescent health
promotion in a preventive-care setting. Health Educ Res 2007; 22(1):1-13.
12. Ferney SL, Marshall AL. Website physical activity interventions: preferences of potential users. Health Educ Res 2006; 21(4):560-6.
G-342
13. Temesgen Z, Knappe-Langworthy JE, St Marie MM, Smith BA, Dierkhising RA. Comprehensive Health Enhancement Support System (CHESS) for
people with HIV infection. AIDS Behav 2006; 10(1):35-40.
14. Owen JE, Klapow JC, Roth DL, Nabell L, Tucker DC. Improving the effectiveness of adjuvant psychological treatment for women with breast cancer: the
feasibility of providing online support. Psychooncology 2004; 13(4):281-92.
15. Lahdenpera TS, Kyngas HA. Patients' views about information technology in the treatment of hypertension. J Telemed Telecare 2000; 6(2):108-13.
16. Weber B, Fritze J, Schneider B, Simminger D, Maurer K. Computerized self-assessment in psychiatric in-patients: acceptability, feasibility and influence
of computer attitude. Acta Psychiatr Scand 1998; 98(2):140-5.
17. Jenkinson J, Wilson-Pauwels L, Jewett MA, Woolridge N. Development of a hypermedia program designed to assist patients with localized prostate
cancer in making treatment decisions. J Biocommun 1998; 25(2):2-11.
18. Paperny DM. Computerized health assessment and education for adolescent HIV and STD prevention in health care settings and schools. Health Educ
Behav 1997; 24(1):54-70.
19. McTavish FM, Gustafson DH, Owens BH et al. CHESS: An interactive computer system for women with breast cancer piloted with an under-served
population. Proc Annu Symp Comput Appl Med Care 1994; 599-603.
20. Cavan DA, Everett J, Plougmann S, Hejlesen OK. Use of the Internet to optimize self-management of type 1 diabetes: preliminary experience with
DiasNet. 2003; 9 Suppl 1.
21. Feil EG, Glasgow RE, Boles S, McKay HG. Who participates in internet-based self-management programs? A study among novice computer users in a
primary care setting. 2000; 26(5):806-11.
22. Zeman L, Johnson D, Arfken C, Smith T, Opoku P. Lessons learned: challenges implementing a personal digital assistant (PDA) to assess behavioral
health in primary care. Families, Systems & Health: The Journal of Collaborative Family HealthCare 2006; 24(3):286-98.
23. Bryce CL, Zickmund S, Hess R et al. Value versus user fees: perspectives of patients before and after using a web-based portal for management of
diabetes. Telemed J E Health 2008; 14(10):1035-43.
24. Leslie E, Marshall AL, Owen N, Bauman A. Engagement and retention of participants in a physical activity website. 2005; 40(1):54-9.
25. Ferrer-Roca O, C+írdenas A, Diaz-Cardama A, Pulido P. Mobile phone text messaging in the management of diabetes. 2004; 10(5):282-5.
26. Lenert L, Mu+_oz RF, Stoddard J et al. Design and pilot evaluation of an internet smoking cessation program. 2003; 10(1):16-20.
27. Kressig RW, Echt KV. Exercise prescribing: Computer application in older adults. 2002; 42(2):273-7.
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28. Brug J, Glanz K, Van Assema P, Kok G, Van Breukelen GJP. The Impact of Computer-Tailored Feedback and Iterative Feedback on Fat, Fruit, and
29. Boberg EW, Gustafson DH, Hawkins RP et al. Development, acceptance, and use patterns of a computer-based education and social support system for
people living with AIDS/HIV infection. 1995; 11(2):289-311.
30. Shaw MJ, Beebe TJ, Tomshine PA, Adlis SA, Cass OW. A randomized, controlled trial of interactive, multimedia software for patient colonoscopy
education. 2001; 32(2):142-7.
31. Strecher VJ, Kreuter M, Den Boer D-J, Kobrin S, Hospers HJ, Skinner CS. The effects of computer-tailored smoking cessation messages in family
practice settings. 1994; 39(3):262-70.
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Evidence table 42. Characteristics of consumers in studies addressing barriers to CHI applications
Control
Author, Education, Gender, Marital Other
year Interventions Age Race, n(%) Income n(%) SES n(%) status characteristics
Simon, Mean, 56.68 AA: 26 (40) USD <8 yr, 22 NS NS Internet access:
1
2008 range, 36-89 Caucasian: 39 <20,000, 20 (34) Use, 52 (80),
SD, 11.22 (60) (31) 8-12 yr, 27 computer at home,
20,000-50,000, (41) 52 (80)
11 (17) 12-16 yr,16 internet at home,
>50,000, 29 (25) 46 (71)
(45)
Frequency on-line:
Daily, 27 (42)
several times a
week, 11 (17)
once a week or
less, 14 (22)
never, 13 (20)
Cimino, No control NS NS NS NS NS
2
2001 group
Keselman, No control White non- 8-12 yr, 9 M, 14
20073 group Hispanic, 95 12-16 yr, 48 F, 89
API, 2 >16 yr, 39
Other, 5
Shaw, CHESS users Mean, 51.81 White non- NS Some junior NS NS Stage of cancer:
20084 SD, 12.11 Hispanic, high, 1 (0.7) Early stage (stage
144(100) Some high 0, 1, 2),
school, 12 97 (67.4)
(8.3)
High school
degree, 48
(33.3)
Some
college, 39
(27.1)
Nijland, No control NS NS NS NS NS NS NS
20085 group
Morak, Obese patient Mean, 48 NS NS NS NS NS BMI:
20086 with mobile range, 24-71 mean, 35.6
phone SD, 5.2
Steele, Face to face Mean, 38.3 NS NS NS NS NS BMI:
20077 n,52 SD, 12.6 mean, 31.59
SD, 7.47
Physical activity:
mean, 76.4
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Evidence table 42. Characteristics of consumers in studies addressing barriers to CHI applications (continued)
Control
SD, 93
H/O internet use :
<6 months, 9(17.3)
6-12 months=1
(1.9)
1-1.5 yr, 5 (9.6)
>2 yr, 6 (11.5)
Steele, Intervention Mean, 39.3 NS NS NS M, NS BMI:
7
2007 SD, 14.4 11 (21.6) mean, 31.63
F, SD, 7.9
40 (78.4)
Physical activity:
mean, 80.8
SD, 96.8
H/O internet use :

<6 months,
1(2.0)
6-12 months,
2 (3.9)
1-1.5 yr, 3 (5.9)
>2 yr, 7 (13.7)
H/O internet use :

<6 months,
1(2.0)
6-12 months,
2 (3.9)
1-1.5 yr,3 (5.9)
>2 years,7 (13.7)
Wangberg, No control Mean, 37.3 NS NS NS NS F, (63) NS Type I Diabetes:72
20088 group, range, Insulin use:78
33.2–41.4 HbA1C:7.7
Wangberg, High self- Mean, 42.9 NS NS 8-12 yr, (8) F,(50) NS Type I
8
2008 efficacy range, Diabetes:(50)
38.0–47.9 Insulin use: (71)
Lober, All participants Mean, 69 NS NS NS NS F,(82) NS
9
2006 range, 49-92
Stock, All subjects Mean, 30.8 NS NS NS NS NS
10
2006 n,32 range, 18-54
SD, 12.1
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Control
Mangunkusu Intervention Mean, 15 Dutch, (76.5) Lower NS M,(43.9) NS
mo, range, 13-17 Other, (23.5) secondary/
200711 Vocational,
(59.1)
International
secondary,
(18.6)
Upper
secondary,
(22.3)
Ferney, Define, low NS NS NS NS NS NS NS
12
2006 self-efficacy
Ferney, Study group 18-44 yr, 16 NS NS 12-16 yr, 23 Employed Married/ Physical activity:
200612 45-65 yr, 24 partner: sufficient, 24
31
Temesgen, Range, 30- White non- All finished NS Employment:
200613 59 Hispanic, high school over half were
7(87.5) employed
NS, 1, (12.5)
Owen, Intervention Mean, 53.9 White non- USD Yr NS Clinical Stage (%):
200414 Hispanic, (84) median, mean, 14 1:28.7
Black non- 45,000 2:40.1
Hispanic, (16) 3:11.5
4:19.7
Lahdenpera, Intervention Mean, 46 NS NS NS Low, 13 M, NS
200015 range, 32-63 higher 9 (42.9)
income, F,
14 12 (57.1)
Weber, Comparison Mean, 30.5 NS NS NS NS NS NS
199816 SD, 7.8
Weber, Patients Mean, 50.7 NS NS NS NS NS
16
1998 SD, 19.4
Jenkinson, No control NS NS NS NS NS NS NS
17
1998 group
Paperny, Public School Mean, 15.5 NS NS NS NS F, (51) NS
199718 range, 15-
Paperny, Medical clinics/ Range, 13- NS NS NS NS

199718 health fairs 19
Paperny, Detainees and Mean, 15.4 NS NS NS NS NS NS
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Control
199718 runaways range 13-
McTavish, Intervention Range, 36- NS NS NS NS NS Computer
19
1994 66 experience:
Any prior:
Cavan, Patients with Mean, 36 NS NS NS NS NS
200320 type 1 diabetes range, 29-61
n,6
Feil, Define, healthy NS NS NS NS NS NS NS
200021 group
Feil, Participants Mean, 59.2 NS NS NS NS NS Own computer,53.1
200021 SD, 6.9 Familiar with
computers ,
1.7 (0.68)
Years diagnosed,
9.5 (7.7)
Zeman, Participants NS Black non- USD 12-16 yr, NS NS NS
22
2006 Hispanic, (83) <30,000, ( 40) (65)
Bryce, Preportal mean, 53 Nonwhite, 7(33) High school Owns a computer (%)
200823 group SD, 13 graduate 6 13 (62)
(29) Type 1 diabetes (%)
Some college 1 (5)
7 (33)
College
graduate 2
(10)
Postgraduate
degree 6 (29)
portal-user mean, 55 Nonwhite, 4(22) High school Owns a computer (%)
group SD, 11 graduate 1 (6) 17 (94)
Some college Type 1 diabetes (%)
5 (28) 2(11)
College
graduate
4(22)
Postgraduate
degree 8 (44)
Leslie, Print mean age of 72% had
24
2005 43 years completed
Website- secondary
delivered school or
intervention higher
Ferrer-Roca, Participants range 18-75
25
2004
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Control
Lenert, Participants mean, 46yrs Caucasian, (84) some F (78) 15 of 34 had no or
26
2003 college very little computer
education experience
(75)
Kressig, Participants mean, 70.4 some M 17
200227 SD, 6.9 college F 17
range, 60 - education or
87years more, 33
Brug, Control mean, 44 college F (82)
199828 SD, 14 degree (42)
Intervention
Boberg, CHESS (the mean, White, (78.1) Average Average No (47.8) M (82.8) Living AI DS Stage
199529 Comprehensiv 34.9yrs Non-White, $15,010 13.9 years Yes (52.2) F 17.2 Status Symptomatic (65.5)
e Health (21.9) Alone(24. Nonsymptomatic
Enhancement 8) (34.5)
Support Not alone
System) (75.2)
Shaw, Interactive mean, College F (56) some exposure to
200130 Computer- 53.9yrs degree, (58) computers (88)
assisted SD, 13.83yrs
Instruction
Program
Strecher, Control mean, F (67.7)
199431 49.5yrs
Intervention
AA = African-American, Yr = year, NS = Not specified, SD = standard deviation, SES = Socioeconomic Status, M = Male, F = Female, USD = United States Dollar
C = Caucasian, BMI = body mass index, API = Asian/Pacific Islander
Reference List
Proc 2007; 399-403.
4. Shaw BR, Dubenske LL, Han JY et al. Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application
G-349
of the Cognitive-Social Health Information Processing (C-SHIP) model. J Health Commun 2008; 13(4):389-408.
Couns 2007; 67(1-2):127-36.
11. Mangunkusumo R, Brug J, Duisterhout J, de Koning H, Raat H. Feasibility, acceptability, and quality of Internet-administered adolescent health
promotion in a preventive-care setting. Health Educ Res 2007; 22(1):1-13.
13. Temesgen Z, Knappe-Langworthy JE, St Marie MM, Smith BA, Dierkhising RA. Comprehensive Health Enhancement Support System (CHESS) for
people with HIV infection. AIDS Behav 2006; 10(1):35-40.
16. Weber B, Fritze J, Schneider B, Simminger D, Maurer K. Computerized self-assessment in psychiatric in-patients: acceptability, feasibility and influence
of computer attitude. Acta Psychiatr Scand 1998; 98(2):140-5.
17. Jenkinson J, Wilson-Pauwels L, Jewett MA, Woolridge N. Development of a hypermedia program designed to assist patients with localized prostate
cancer in making treatment decisions. J Biocommun 1998; 25(2):2-11.
Behav 1997; 24(1):54-70.
G-350
20. Cavan DA, Everett J, Plougmann S, Hejlesen OK. Use of the Internet to optimize self-management of type 1 diabetes: preliminary experience with
DiasNet. 2003; 9 Suppl 1.
education. 2001; 32(2):142-7.
31. Strecher VJ, Kreuter M, Den Boer D-J, Kobrin S, Hospers HJ, Skinner CS. The effects of computer-tailored smoking cessation messages in family
practice settings. 1994; 39(3):262-70.
G-351
Evidence table 43. All barriers identified to the use of CHI applications
Author, DATA collection

year Barriers and target conditions method Comment Conclusions
Simon, Barrier type: user-level barriers Non-validated survey Respondents also cited This finding suggests that, in
20081 Other: privacy incentives to use an electronic this population, computer
Barrier under study: CHI application use too tool for recording family h/o literacy and Internet access per
time consuming; confidentiality/privacy; control cancer: save time, help se may not be the most
of information; lack of technical infrastructure. researchers and help speed important predictors of whether
Patient preferences: not comfortable giving research for people "in their mammogram patients are or
history to provider in person either; did not need culture", to pass on to family, are not interested in using an
a risk assessment; using an electronic tool to something new. online computer program to
record data as opposed to paper and pen record their FHC. As a result, a
Other important barriers identified during challenge of research on the
study: knowledge literacy. clinical utility of electronic tools
Target condition: breast cancer; any form of for recording FHC will be to
familial cancer. characterize the contexts in
Other: family history of cancer which they are deployed, with
regard to what users (and
nonusers) understand about
security and privacy of online
information, and the means
whereby the computer tool is
integrated into clinical care or
research.
Cimino, Barrier type: user-level barriers; systems-level Non-validated survey use of the system enhanced
2
2001 barriers. Qualitative patient understanding of their
Barrier under study: application usability; condition and improved patient-
incompatibility with current care; knowledge physician communication
literacy; lack of technical infrastructure.
Target condition: personal health record
Keselman, Barrier type: user-level barriers; systems-level Non-validated survey the present study suggests that
20073 barriers. work in the area of machine
Barrier under study: application usability; translation into consumer
confidentiality/privacy; control of information; friendly forms, user-friendly
knowledge literacy; language. presentation of difficult
Target condition: multiple -patients' concepts and multiple-view
information and comprehension needs related representation have the
to their medical records. promise of improving health
records review experience for
lay readers
Shaw, Barrier type: user-level barriers Validated survey C-SHIP Model Factors Cancer- The variables associated with
20084 Barrier under study: cultural; knowledge relevant encodings and self- the C-SHIP model appeared to
literacy. Patient preferences: construal’s functional well-being have more frequent
beliefs affect goals & values; well being Cancer-relevant beliefs and relationships with experiential
(functional and emotional) expectancies. Health self- as compared with didactic
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Evidence table 43. All barriers identified to the use of CHI applications (continued)

Target condition: breast cancer. efficacy. Cancer-relevant information seeking.
affects. Emotional well-being
Negative emotion Cancer-
relevant goals and values Need
for information Cancer-relevant
self-regulatory competencies
and skills Participation in health
care Health information
competence Barriers to
information Social support
Nijland, Barrier type: user-level barriers; systems-level Qualitative "caregiver" means physician in Quality Demand Identified
20085 barriers. this article Patient Problems User-
Barrier under study: application usability; friendliness (n = 106, 40.8%)
incompatibility with current care. Navigation problems: Lack of a
Target condition: various health complaints - search engine Lack of an
symptom review adequate search option
Unclear navigation structure;
hyperlinks were nonexistent or
useless Unclear or unattractive
layout of Web pages No
features for printing information
Technical problems: Software
bugs Drop-down menus or
back buttons failed Quality of
care (relevance,
comprehensibility of
information; responsiveness) (n
= 146, 56.1%) Problems with
relevance of information:
Information provided by the
digital medical encyclopedia
was too general to be useful
Information provided by the
virtual body was too limited to
be useful Self-care advice
insufficiently tailored to
personal needs Problems with
comprehensibility of
information: Semantic
mismatch between system and
users because of unclear
medical terms and lack of
features to verbalize a problem
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in their own vocabulary Self-
care advice hard to interpret
Self-care advice frightening
Problems with responsiveness:
Caregiver used more than
prescribed response time to
answer patients¡¯ questions
Implementation (policy,
training) (n = 8, 3.1%) Lack of
education: Underuse or misuse
of applications because of lack
of education Uncertainty about
regulations for using Internet
for self-care
Morak, Barrier type: user-level barriers Non-validated survey About half of all participants
20086 Barrier under study: application usability ; CHI were able to perform the data
application use too time consuming; acquisition procedure after
Barrier under study: lack of technical studying the manual without
infrastructure ; Patient preferences: opinion of any additional explanation. In a
using own mobile phone or PC few cases they obtained
Target condition: obesity technical assistance from
younger relatives. It was mainly
patients with poor technical
skills who contacted the
helpdesk and requested further
tuition by telephone
Steele, Barrier type: systems-level barriers. Non-validated survey Preference and satisfaction.
7
2007 Barrier under study: application usability; Qualitative Face to face=92% IM=69%
knowledge literacy; lack of technical IO=65% On a scale of 1–5
infrastructure. (strongly disagree to strongly
Target condition: physical activity/diet agree) participants were also
asked to rate their overall
satisfaction related to
understanding of the program
content, and credibility of the
information provided (Table 3).
No significant differences in
ratings across intervention
groups were found.
Participants reported similar
means across groups for
credibility [F(2, 154) = 1.36; p >
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0.05] and understanding [F(2,
154) = 1.35; p > 0.05].
Responses to the ‘personal
relevance and usefulness of
the program activities’ in the
FACE group were also high
(4.3 0.69) (this item was
assessed under website
acceptability for the IM and IO
groups). Seventy-four percent
of IM, and 57% of the IO
participants reported accessing
the website from home. The
rest of the IM participants
accessed the Internet from
work with a small percentage
using Internet cafes and
friends. The rest of the IO
participants accessed the
Internet outside of the home
environment with the majority
being at work, and a small
percent at Internet cafes and
university/cafe campuses. In
terms of website usability,
(user-friendliness,
presentation, navigation, and
relevance) participants rated
the website favorably as shown
in Table 4. There were no
significant differences between
IM and IO (p > 0.05).
Wangberg, Barrier type: User level Non-validated survey, Perceived usefulness might The mean score on perceived
20088 Barrier under study: scale was not also be seen as a user lever usefulness was 3.6 (CI95% =
Patient preferences: perceived usefulness; lack reported barrier 3.1–4.1), which corresponds to
of viral marketing; number of accesses. a slightly positive attitude.
Target condition: diabetes There was no difference in
perceived usefulness between
the two groups, F(1,27) = 0.29,
P = .60 Four of 28 (14%)
users would recommend the
site to a friend. Use of the site
was greatest during the first
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days, and declined rapidly
thereafter. The mean time
spent on the site was 45.2 min
(CI95% = 37.1– 53.3), and the
mean number of visits was 5.9
(CI95% = 3.9–8.0). The
checkbox for the targeted daily
self-care behavior was
accessed most often, while
only 4 of 28 users had
downloaded any videos. There
was no significant correlation
between total time spent at the
site and improvement in
selfcare,
r = .10, P = .60, nor between
time spent at the site and
perceived usefulness, r = .04,
P = .83.
Lober, Barrier type: user-level barriers Empirical based on Elderly and disabled residents
9
2006 Barrier under study: knowledge literacy; trial data. of the EHA were able to create
physical limitations; cognitive impairment; Report by the nurse and maintain a PHR, although
health literacy; computer anxiety. helping the patient to the majority could not do so
Target condition: PHR use by elderly use the system. independently due to computer
population. anxiety and a lack of computer
literacy, cognitive and physical
impairments, and health
literacy
Stock, Barrier type: systems-level barriers. Empirical based on The average number of see comments
10
2006 Barrier under study: application usability. trial data prompts for participant to
Target condition: intellectual disabilities. complete the navigation using
the pocket voyager interface
was 1.41, while the average
need for assistance when using
the mainstream windows CE
operating system was 5.34.
Similarly participant made an
average of only .78 errors when
using the PVP.
Compared to an average of
3.22 errors made when using
the mainstream interface. One
G-356

of the major barriers to access
in the mainstream windows CE
operating system is it
complexity(several different
methods for accomplishing the
same task), button icons by
themselves did not provide
enough information to
participants (non-readers) to
enable independent program
identification
Mangunkusumo, Barrier type: systems-level barriers Validated survey Using the Internet for the
11
2007 Barrier under study: application usability. Non-validated survey adolescent preventive health
Patient preferences: acceptability; usability; care procedure is feasible and
credibility positively evaluated by users.
Target condition: physical activity/diet
(specify)
Ferney, Barrier type: systems-level barriers. Qualitative Four major themes emerged,
200612 Barrier under study: application usability. relating to ‘design’,
Patient preferences: no published studies on ‘interactivity’, ‘environmental
user-centered website design and development context’ and ‘content’.
Target condition: physical activity website. Recommendations for features
and services recommended by
participants under each of
these themes are summarized
in in the reported barriers
column (question 3)
Temesgen, Barrier type: user-level barriers; systems-level Non-validated survey They gave patients laptops and our patient population was
200613 barriers internet access so did not mainly rural-based adding
Barrier under study: application usability ; CHI assess the barrier. geographic isolation and a
application use too time consuming; relative lack of access to
incompatibility with current care; knowledge computers and the Internet to
literacy; lack of technical infrastructure the many other difficulties
Patient preferences: goals and expectations; commonly shared by HIV-
finances infected people It was of
Target condition: HIV/AIDS interest to us to determine
whether the ever-increasing
complexities of HIV medicine
and the transformation of HIV
infection into a chronic
Condition will be reflected in a
greater utility and appreciation
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for systems like CHESS.
Owen, Barrier type: user-level barriers Non-validated survey( An increasing percentage of
200414 Barrier under study: application usability; lack did examine internal women with breast cancer,
of technical infrastructure. consistency) nearly 70% in our most recent
Patient preferences: expect internet based sample, have access to the
therapy to work. internet, and nearly 66% report
Target condition: breast cancer. that internet-based APT is
equally or more likely to result
in improved physical and
mental health than face-to-face
therapy. When made aware of
the availability of participating
in internet-based APT, 45%
asked to become a member of
a small therapy group. Among
patients who had access to the
Internet and declined to
participate, few cited logistical
constraints as a reason for not
being involved.
Lahdenpera, Barrier type: user-level barriers Qualitative Even though the patients
15
2000 Barrier under study: confidentiality/privacy; understood that the treatment
incompatibility with current care; knowledge of hypertension was up to
literacy; lack of technical infrastructure. them, they felt the need for
Patient preferences: lack of personal contact something to remind them
with provider; patients attitude to IT about the treatment. Their
Target condition: hypertension experience of IT and whether
or not they had a computer at
home did not influence the
decision to participate in the
intervention “If there is now is
edoctorusing another computer
at the health centre, there will
be no benefit in using it. But
when there is a doctor or a
nurse, we get help from them,
and then it is a good thing to
use."
Weber, Barrier type: user-level barriers Validated survey Mixed results as far as the
16
1998 Barrier under study: CHI application use too Non-validated survey relationship between
time consuming; knowledge literacy. experience or attitude and
Patient preferences: opinion of the survey.
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Target condition: mental health: psychiatric
inpatients
Jenkinson, Barrier type: user-level barriers Qualitative Patients confirmed their need
17
1998 Barrier under study: application usability for more information about the
Patient preferences: visual preferences and diagnosis of prostate cancer,
information needs of patients. available treatments and side
Target condition: cancer: prostate effects. Patients confirmed the
computer as a suitable vehicle
for conveying information.
Visual preferences were noted
about the
interface/design/layout/type.
Paperny, Barrier type: user-level barriers Qualitative Interactive, computer-assisted Avoidance, mistrust, discomfort
18
1997 Barrier under study: confidentiality/privacy; identification of high-risk and breach of confidentiality in
control of information; incompatibility with behaviors and health needs is sharing sensitive problems is
current care. thorough, accurate, painless, almost eliminated with this
Patient preferences: automated health and easy and saves interviewer automated method of interview
education. time. and health education
Target condition: HIV/AIDS
Other: STD
McTavish, Barrier type: user-level barriers Empirical based on The geographic barrier CHESS appears to be
19
1994 Barrier under study: application usability ; trial data (location, cost, child care) were extremely user-friendly and
knowledge literacy Non-validated survey easily over some by their in- lack of computer experience is
Target condition: breast cancer. home use of the CHESS not a barrier to use.
computer
Cavan, Barrier type: User barriers Pilot study Internet access is becoming No data
20
2003 Barrier under study: application usability ; more reliable, a rapid and
internet access preferably automated method
Target condition: diabetes of data entry would minimize
the risk of data loss.
Feil, Barrier type: user-level barriers Non-validated survey The home based intervention The result shows the internet
21
2000 Barrier under study: application usability; CHI was free of charge, convenient intervention can appeal to a
application use too time consuming; knowledge (the participant were loaned a wide range of type 2 patients
literacy; lack of technical infrastructure; access. specialized computer) and regardless of gender, disease
Target condition: diabetes designed to mitigate frequent severity and computer
participation barriers such as familiarity, thus mirroring the
cost, transportation, child care, general public's adoption of the
travel costs and work internet
schedules
Zeman, Barrier type: user-level barriers; systems-level Empirical based on Lack of physician interest and Lack of physician interest and
200622 barriers trial data motivation is a critical barrier motivation is a critical barrier
Barrier under study: application usability ; CHI Non-validated survey; even if technology offers a low- even if technology offers a low-
G-359

application use: too time consuming; research assistant cost alternative, requires few cost alternative, requires few
confidentiality/privacy; control of information ; recorded this additional resources, is easy to additional resources, is easy to
cultural; Knowledge literacy; utility; use, and provides evidence- use, and provides evidence-
Target condition: mental health : range of based diagnostic and treatment based diagnostic and treatment
psychiatric conditions information. information.
Bryce, Barrier type: user-level barriers, systems-level Qualitative In general, preportal Potential and actual users of a
200823 barriers. participants anticipated features diabetes portal favored
Barrier under study: Comparison of preportal to be more useful than portal capabilities aimed largely at
participants to portal users about interest in a users actually found them to self management, education,
number of features of a portal. Also, participants be, with the exception of and communication, but ratings
were queried about the acceptability of fees. electronic communication with of actual users were not better
The substantial investment to develop a portal healthcare practices. Most than those of potential users.
was discussed as a system level barrier. participants did not find fees Most participants were
Target condition: diabetes acceptable. opposed to paying for access.
Leslie, Barrier type: User-level barriers Non-validated survey The use of websites to deliver
24
2005 Barrier under study: application usability health behavior change
Target condition: Physical Activity/ Diet/ programs provides many new
Obesity opportunities and challenges
Websites may be a far more
‘passive’ medium than has
been previously assumed. It
may be necessary to make
websites more dynamic and to
update website material
regularly to make them more
appealing and useful to
potential users. The key
challenge in providing effective
programs is in finding the most
appropriate methods to
recruit, actively engage and
maintain participant interest in
the program materials.
Ferrer-Roca, Barrier type: User-level barriers, systems-level Non-validated survey the trial results suggest that
200425 barriers. SMS may provide a simple,
Barrier under study: application usability, User fast, efficient and low-cost
satisfaction adjunct to
Target condition: Diabetes the medical management of
diabetes at a distance. In
our case it was particularly
G-360

useful for elderly persons
and teenagers, age groups that
are known to have
difficulty in controlling their
diabetes well.
Lenert, Barrier type: User-level barriers Non-validated survey this pilot study suggests that
200326 Barrier under study: application usability, design of Internet applications
complex design that motivate changes
Target condition: Smoking Cessation in health behavior may need to
differ from applications
designed to educate and
inform.
Kressig, Barrier type: user-level barriers Non-validated survey the data from this study
27
2002 Barrier under study: application usability, user support the potential of
friendliness interactive technology in health
Target condition: Physical Activity/ Diet/ promotion
Obesity among the expanding older
population
Brug, Barrier type: user-level barriers Non-validated survey computer-generated
199828 Barrier under study: application usability individualized feedback can be
Target condition: Physical Activity/ Diet/ effective in inducing
Obesity recommended dietary changes
and that iterative feedback can
increase the longer term
impact of computertailored
nutrition education on fat
reduction.
Boberg, Barrier type: user-level barriers Non-validated survey This study demonstrates that
29
1995 Barrier under study: application usability computers, which are often
Target condition: HIV/AIDS characterized as sterile,
information-
only, and intimidating, can be
used very successfully to
provide information,
analysis, and support to people
facing a health crisis such as
HIV infection
Shaw, Barrier type: System-level barriers Non-validated survey The results of this study
30
2001 Barrier under study: application usability demonstrate that the addition
Target condition: all cancer of a multimedia interactive
program to the process of
patient education may
G-361

affect patient satisfaction and
the delivery of information
required for informed consent
Strecher, Barrier type: User-level barriers Non-validated survey Results from both studies
199431 Barrier under study: application usability indicate positive effects of
Target condition: Smoking Cessation computer-tailored smoking
messages among moderate to
light smokers
Reference List
Proc 2007; 399-403.
4. Shaw BR, Dubenske LL, Han JY et al. Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application of
the Cognitive-Social Health Information Processing (C-SHIP) model. J Health Commun 2008; 13(4):389-408.
Couns 2007; 67(1-2):127-36.
11. Mangunkusumo R, Brug J, Duisterhout J, de Koning H, Raat H. Feasibility, acceptability, and quality of Internet-administered adolescent health promotion in
a preventive-care setting. Health Educ Res 2007; 22(1):1-13.
G-362
13. Temesgen Z, Knappe-Langworthy JE, St Marie MM, Smith BA, Dierkhising RA. Comprehensive Health Enhancement Support System (CHESS) for people
with HIV infection. AIDS Behav 2006; 10(1):35-40.
16. Weber B, Fritze J, Schneider B, Simminger D, Maurer K. Computerized self-assessment in psychiatric in-patients: acceptability, feasibility and influence of
computer attitude. Acta Psychiatr Scand 1998; 98(2):140-5.
17. Jenkinson J, Wilson-Pauwels L, Jewett MA, Woolridge N. Development of a hypermedia program designed to assist patients with localized prostate cancer
in making treatment decisions. J Biocommun 1998; 25(2):2-11.
Behav 1997; 24(1):54-70.
20. Cavan DA, Everett J, Plougmann S, Hejlesen OK. Use of the Internet to optimize self-management of type 1 diabetes: preliminary experience with DiasNet.
2003; 9 Suppl 1.
G-363
education. 2001; 32(2):142-7.
31. Strecher VJ, Kreuter M, Den Boer D-J, Kobrin S, Hospers HJ, Skinner CS. The effects of computer-tailored smoking cessation messages in family practice
settings. 1994; 39(3):262-70.
G-364
Evidence Table 5. Description of RCTs addressing KQ1b (impact of CHI applications on intermediate outcomes)
Year data
Breast cancer
Gustafson, Individuals Interactive Home/ Accrued <60 yr, Given copy CHESS 1
20011 interested consumer residence between Women within 6 of Dr. Susan intervention on
in their own computer- April 1995 months of diagnosis Love’s home computer
health care based and May of breast cancer, Breast Book connecting to
program 1997 Not homeless, central server
able to give informed
consent,
Understand and
answer sample
questions from the
pretest Not active
illegal drug users
Gustafson, Individuals Interactive Home/ NS Women within 61 1.Choice of CHESS 2
20082 interested consumer residence days of breast several interactive
in their own website cancer diagnosis. books on website,
health care Not homeless, breast General website
able to give informed cancer or set and the Internet
consent, of audiotape
understand and OR
answer sample 2. Access to
questions from the the Internet
pretest
Jones, Individual Interactive Clinician 1996-1997 Existing breast, Receiving 1. Booklet Personalized 1
19993 interested consumer office patients cervical, prostate, or palliative information- information-
in their own website identified laryngeal, cancer treatment, 2. General summary of
health care patients receiving No knowledge of information their medical
radiotherapy at one diagnosis, about record &
oncology center visual or mental cancer, hypertext links
handicap , organized on to terms.
severe pain or computer as Access to
symptoms hypertext general system
document menu
Yr = year, CHESS = Comprehensive Health Enhancement Support System, NS = Not specified
G-25
Evidence Table 5. Description of RCTs addressing KQ1b (impact of CHI applications on intermediate outcomes) (continued)
Reference List
G-26
Evidence Table 6. Description of consumer characteristics in RCTs addressing the impact of CHI applications on intermediate outcomes (KQ1b)
Author, Control Education, n Gender, Marital

Year Intervention Age Race, n(%) Income (%) SES n (%) Status Other characteristics
Breast cancer
Gustafson, Allocated Mean, 44.4 White non- USD 12-16yr,( 40.2) NR Living with Insurance:
1
2001 standard SD, 7.1 Hispanic (72) 40,000, partner, Private Insurance,
intervention (50.8) (72.6) (84.7)
Received Mean, 44.3 White non- USD 12-16 yr, (45.8) NR Living with Insurance:
CHESS SD, 6.6 Hispanic (76) 40,000, partner, Private Insurance,
intervention, a (58.1) (71.9) (86)
home based
computer system
Usual Care with
Gustafson, books NS NS NS NS NS NS NS NS
2
2008 NS NS NS NS NS NS NS NS
Booklet
Jones, information NS NS NS NS NS NS NS NS
3
1999 NS NS NS NS NS NS NS NS
NS= Not Specified, SD= Standard Deviation, SES= Socioeconomic Status, Yr= year, USD = United States Dollar
Reference List
G-27
Evidence table 7: Outcomes in studies addressing KQ1b, impact of CHI application on intermediate outcomes

Author, Outcomes Control n Measure Measure at Measure at Mean difference Significance
year at BL time point 2 final time (95% CI)
Intervention point
Gustafson, Social Support Control 125 2 month 5 month 2 mos: 2.4 (-1.2-5.9) 2 mos: NS
1
2001 mean,78.4 mean, 79.3 5 mos: 4.9 (1.4-8.4) 5 mos: p <0.01
CHESS 121 2 month 5 month
mean,80.2 mean, 84.2
Information Control 125 2 month 5 month 2 mos: 4.8 (1.5-8.1) 2 mos: p <0.01
competence mean, 65.6 mean, 65.8 5 mos: 3,5 (0.0-6.9) 5 mos: p 0.05

mean, 70.4 mean, 69.3
Unmet Control 125 2 month 5 month 2 mos: 2.8 (-2.7-8.4 2 mos: NS
information mean, 67.2 mean, 69.6 5 mos: -2.6 (-8.2-2.9) 5 mos: NS
needs CHESS 121 2 month 5 month
mean, 70.0 mean, 67.0
Participation, Control 125 2 month 5 month 2 mos: 2.5 (-1.1-6.1) 2 mos: NS

behavioral mean, 73.1 mean, 72.8 5 mos: 1.7 (-2.3-5.6) 5 mos: NS
involvement CHESS 121 2 month 5 month
mean, 75.6 mean, 74.5
Participation, Control 125 2 month 5 month 2 mos: 6.4 (2.1-10.7) 2 mos: p <0.01
level of comfort mean, 74.3 mean, 76.5 5 mos: 2.6 (-1.4-6.7) 5 mos: NS

mean, 80.7 mean, 79.1
SD,
Confidence in Control 125 2 month 5 month 2 mos: 5.7 (1.0-11.3) 2 mos: p <0.05
doctors mean, 77.3 mean, 79.0 5 mos: 3.8 (-2.2-9.8) 5 mos: NS

mean, 83.0 mean, 82.8
G-28

Evidence table 7: Outcomes in studies addressing KQ1b, impact of CHI application on intermediate outcomes (continued)
2 month Effect size 4 month Effect size 9 month Effect size (p

(p value) (p value) value)
Gustafson, Social Control 83 CHESS 0.32 (0.039) 78 CHESS 0.46 75 CHESS 0.38 (0.021)*
2
2008 support minus minus (0.004)** minus
control: control: control:
mean, 0.16 mean, 0.25 mean, 0.21
SD, 0.49 SD, 0.53 SD, 0.55
Internet 79 Internet -0.14 (.39) 80 Internet 0.05 (0.77) 75 Internet 0.10 (0.57)
minus minus minus
mean, -0.08 mean, -0.03 mean, 0.06
SD, 0.56 SD, 0.60 SD, 0.58
CHESS 90 CHESS 0.47 85 CHESS 0.35 (0.027) 80 CHESS 0.24 (0.14)
minus (0.003)** minus minus
Internet: Internet: Internet:
mean, 0.16 mean, 0.20 mean,0.13
SD, 0.49 SD, 0.56 SD, 0.54
Health & Control 83 CHESS 0.25 (0.126) 78 CHESS 0.17 (0.32) 75 CHESS 0.38 (0.028)
information minus minus minus
competence control: control: control:
mean, 0.12 mean, 0.07 mean, 0.18
SD, 0.47 SD, 0.40 SD, 0.48
Internet 79 Internet -0.06 (0.69) 80 Internet -0.10 (.53) 75 Internet 0.12 (0.48)
minus minus minus
mean, -0.03 mean, -0.05 mean, 0.06
SD, 0.48 SD, 0.45 SD, 0.49
CHESS 90 CHESS 0.44 85 CHESS 0.23 (0.15) 80 CHESS 0.24 (0.16)
minus (0.007)** minus minus
Internet: Internet: Internet:
mean, 0.17 mean, 0.19 mean, 0.12
SD, 0.39 SD, 0.40 SD, 0.37
* “p<0.05. CHESS vs. control and Internet vs. control comparisons share alpha, thus p<0.025 for significance”
** “p<0.01. CHESS vs. control and Internet vs. control comparisons share alpha, thus p<0.025 for significance”
NS = not significant, CHESS = Comprehensive Health Enhancement Support System, SD = standard deviation, mos = months, BL = baseline, CI = confidence interval
G‐29

P value of P value of difference

Control difference Computer vs. booklet
Personal vs.
Author, No. (%) general information
year Outcomes intervention n 95% CI on % on computer
Jones, Satisfaction Booklet 150 58 (40) 0.04 (personal 0.77
19993 Score >2 32 to 48 better)
No. (%) a few
days after
Computer- 156 68 (46)
information
Personal 38 to 54
given
Information
via computer
Computer - 128 41 (34)
General 26 to 42
information
about cancer
Prefer computer Booklet 150 12/122(10)
to 10 minute Computer- 156 38/131(29)
consultation Personal
with Information
professional (at via computer
3 months of Computer - 128 22/110 (20) 0.12 <0.001
follow up) General (computer more likely)
information
about cancer
G‐30

Reference List
G‐31

Evidence Table 8. Description of RCTs addressing KQ1b (impact of CHI applications on intermediate outcomes)
Year data
Diet/exercise/physical activity NOT obesity
Adachi, Individuals Tailored Home/ 2002/ 20-65 yr, BMI>30, history of Untailored Computerized 0
20071 interested advice based residence January to BMI greater>24, major medical or self-help behavioral
in their own on answers to September BMI greater> 23 psychiatric booklet with weight control
health care a with mild problems or 7-month self program with
Computerized Hypertension, orthopedic monitoring of 6-month
questionnaire Hyperlipidemia, problems that weight and weight and
or DM prohibited exercise, walking; targeted
received a diet behavior’s self-
and/or exercise Self-help monitoring;
program within 6 booklet only computerized
months, behavioral
currently/previously weight control
/planned to be program only
pregnant within 6
months
Anderson, Consumers Interactive Kiosk NS NS NS No Computerized
2
2001 interested computer based intervention- nutrition
in their own based computers control intervention
health program located in condition
supermark
-ets
Brug, General Computer- Home NS NS NS General Tailored
3
1998 public generated based Information Feedback;
interested feedback Tailored +
in their own letters Iterative
health Feedback
Brug, Individuals Computer- Computer NS NS NS First The second
4
1999 interested tailored based; intervention intervention
in their own nutrition otherwise (comparison (experimental
health education non- group) group), tailored
specified provided letters with
subjects with dietary
personal feedback was
letters with supplemented
tailored by feedback
dietary about personal
feedback outcome
about expectancies,
fat, fruit and perceived
G-32
Year data
vegetables social
only influences and
self-efficacy
expectations
Campbell Adult individually Home Between Office staff patients who were Messages An intervention
5
1994 patients computer- based September recruited too ill or were mailed group, which
from tailored and participants mentally unable to to received
four North nutrition November as they checked in complete the participants tailored
Carolina messages 1991 for any type of baseline nutrition
family medical survey messages; a
practices appointment. comparison
intervention
group, which
received
nontailored
nutrition
messages;
The tailored
intervention
consisted of
a one-time,
mailed nutrition
information
packet tailored
to the
participant's
stage of
change,
dietary intake,
and
psychosocial
information.
Campbell, Low Interactive Facility January 18 years of age or NS No Computer-
19996 income computer based through older, Intervention based
women based (food April, 1995 spoke English and intervention
enrolled in program stamp either had children consisted of a
the Food office) under 18 tailored soap
Stamp living at home or opera and
program were pregnant interactive
‘info-mercials’
G-33
Year data
that provided
individualized
feedback
about
dietary fat
intake,
knowledge and
strategies for
lowering fat
based on
stage of
change
Campbell, Participant CDROM Clinic- NS Being at least 18 Women Control Interactive
20047 s in the program based years of age, deemed as high group tailored
Special receiving risk by the completed nutrition
Supplemen WIC benefits for nutritionist (eg, the surveys education
tal self or child(ren), owing to pregnancy but did not
Nutrition and speaking and complications) receive the
Program understanding were excluded from intervention
for English. For those the study because until
Women, women who were of the probable after follow-
Infants and pregnant or need for more up
Children breast-feeding, it intensive
(WIC) was required that counseling and
they have at least follow-up.
one prior nutrition
session with a
WIC nutritionist
before
being referred to
the computer
program
Haerens, Middle Computer- School Measures NS NS No Intervention
20058 school tailored based were intervention with parental
adolescent feedback assessed at support and
s) the intervention
beginning alone
(September
2003) and
repeated at
G-34
Year data
the end of
the school
year (June
2004).
Haerens, Individuals Interactive Remote Year, 2005 7th grade No 50-min class 0
9
2007 interested computer- location: (November)/ students, intervention (in 7th grade)
in their own tailored school 50 minute parental consent using the
health care intervention intervention computer
(students with 3 month tailored dietary
in follow up fat intake
randomly intervention
selected
7th grade
class)
Haerens, Adolescent Web-based Home February– NS NS Generic Tailored
10
2009 population computer Based March 2007 feedback Feedback
tailored letter letter
intervention
Hurling, Individuals Internet-based Computer NS NS taking of Non- Interactive
11
2006 interested exercise based; prescription interactive Internet-based
in their own motivation otherwise medication, known Internet- physical
health and action non- heart conditions or based activity
support specified related physical system)
system (Test symptoms and activity
system) receipt of advice system)
from a health
professional not to
engage
in physical activity
or exercise
Hurling, Individuals Internet and Home/ Duration, 3 30-55 yr, Employee of No Internet and 2
200712 interested mobile phone residence month, Body mass index Unilever, intervention mobile phone
in their own for self September 19-30, 1 or more items on based
health care reported to Not vigorously the PAR-Q, intervention
physical December, active, 1 or more items on
activity 2005. Not taking regular the Rose Angina
prescription Questionnaire
medication,
Internet and e-
mail access,
G-35
Year data
Mobile phone user
King, people with Interactive Facility NS At least 25 years NS generic Interactive
200613 type 2 CDROM based old; diagnosed health risk CD-ROM
diabetes with type 2 appraisal
diabetes for 6 CD-ROM
months or more;
able to read and
write
in English; and
able to perform
moderate level PA
Kristal, Enrollees Computer- Home- NS GHC enrollment, Living outside of Usual Care Tailored, Self-
200014 of a large generated based age (18–69) and area or no longer Group (no Help Dietary
health personalized an ability to enrolled in GHC intervention) Intervention
maintenan letter and complete the
ce computer baseline survey in
organizatio generated English.
n behavioral
feedback
Lewis, Sedentary Web-based Computer/ January NS NS Standard Motivationally-
200815 adults computer- Home 2003 Internet Tailored
interested tailored based through May Internet
in their own Feedback 2006
health
Low, Individuals Interactive NS 2001 (F) first or second Women with Control Student Bodies 2
200616 interested consumer year college, previous diagnosis with
in their own website northeast private, of eating disorders moderated
health care (Student liberal arts college or who were discussion,
Bodies, currently purging, Student Bodies
with un-
moderated
discussion,
Student Bodies
with no
discussion
Mangunkus Individuals Internet site Remote NS Secondary school Preprinted Tailored 1
umo, interested location students of the generic feedback on
200717 in their own (e.g. same grade advice on fruit
health library fruit consumption
care: internet consumption and an online
G-36
Year data
student-- cafe); and a mailed referral where
with at a referral applicable after
parental secondary where baseline
consent school applicable assessment
after
baseline
assessment
Marcus, Individuals Interactive Home/ 15 Jan 2003 ≥18 yr, History of coronary Tailored print, 3
18
2007 interested consumer residence through 6 sedentary (<90 or valvular heart
in their own website June 2006 minutes of disease, Tailored
health care physical activity Hypertension, internet,
each week) Diabetes mellitus,
chronic obstructive Standard
pulmonary disease, internet
stroke,
osteoarthritis,
orthopedic
problems that
would limit treadmill
testing,
or any other
serious medical
condition that
would make
physical activity
unsafe or unwise,
consuming 3 or
more alcoholic
drinks per day on 5
or more days of the
week,
Current or planned
pregnancy,
planning to move
from the area within
the next year,
current suicidal
ideation or
psychosis,
current clinical
depression and/or
G-37
Year data
hospitalization
because of a
psychiatric disorder
in the past 6
months,
current clinical
depression and/or
hospitalization
because of a
psychiatric disorder
in the past 6
months, taking
medication that
may impair physical
activity tolerance or
performance ,
and/or previous
participation in
exercise trials of
authors
Napolitano, Individuals Interactive Home/ 12 weeks 18-65 years old, Coronary artery Wait list Internet web 0
200319 interested consumer residence, 120 minutes or disease, control site plus
in their own website Remote less of moderate Stroke, group weekly email
health care location: intensity physical Alcoholism or tip sheets
work place activity per week, substance abuse,
60 minutes or less Hospitalization for a
of vigorous psychiatric disorder
intensity physical in the last 3 years,
activity per week Currently suicidal
or psychotic,
Orthopedic
problems that could
limit exercise,
and current or
planned pregnancy
Oenema, Individuals Interactive Classroom NS Insufficient Non-tailored Received we- 0
20
2001 interested consumer or office of understanding of nutrition based tailored
in their own website, adult Dutch information nutrition
health care education letter education
institutes program
G-38
Year data
(sites of
recruitmen
t)
Richardson Sedentary Enhanced Home/ NS At least 18 years If they had used a Participants Participants
, 2007 21 adults with pedometers residence of age and had pedometer in the randomized randomized to
type II with type 2 diabetes. past 30 days or to receive receive SG
Diabetes embedded Eligible were pregnant. LG were were instructed
USB ports, participants also instructed to to focus on
uploaded reported regular e- focus on bout steps.
detailed, time- mail use, and had total They were
stamped step- access to an accumulated encouraged to
count data to Internet- steps. set their
a website connected pedometer to
called computer with a display bout
Stepping Up Windows 2000 or steps (labeled
to Health; and XP operating aerobic steps
received system and an on the Omron
automated available USB. pedometers),
step-count Participants also and they were
feedback, had to be able to assigned
automatically communicate in weekly
calculated English, provide automatically
goals, and written consent, calculated bout
tailored and obtain steps goals
motivational medical clearance based only on
messages to start a walking bout-step data
program from a uploaded from
primary care the previous
physician, week.
endocrinologist, or
cardiologist.
Smeets, Individuals Tailored Home/ 15 months 18-65 yr, Control Intervention -1
22
2007 interested newsletter residence group group,
in their own computer receiving receiving one
health care generated one general tailored letter
based on information
information letter
about the
Individuals
Spittaels, Healthy Web based Home NS 20 and 55 years of NS No website-
G-39
Year data
200723 adults based age, intervention delivered
interested had no history of physical
in their own cardiovascular activity
health diseases, and had intervention –
access to the with or without
Internet computer
tailored
feedback
Spittaels, Individuals Interactive Work NS 25-55 yr, History of Online non- Online tailored 1
200724 interested consumer internet access at cardiovascular tailored physical
in their own website home or work disease standard activity advice
health care physical + email,
activity
advice Online tailored
physical
activity advice
only
Tan, 200525 Individuals Interactive Home/ NS 18-65 yr, No Tailored 1
interested consumer residence, Command of information information,
in their own website Dutch language,
health care Remote Access to Generic
location: computer with a information
work CD-ROM
place,
Vandelanot Individuals Interactive University NS 20-60 yr Complaints related Tailored Tailored 1
26
te, 2005 interested computer- computer to physical activity, physical physical
in their own tailored lab Complaints related activity and activity and fat
health care intervention to fat intake fat intake intake
(cardiovascular Interventions intervention at
disease, after 6 baseline,
diabetes, month FU
anorexia, Tailored
problems with physical
stomach, activity
liver, intervention at
gallbladder or baseline and
intestine) tailored fat
intake
intervention at
3 months,
G-40
Year data
Tailored fat
intake at
baseline, and
tailored
physical
activity at 3
months
Verheijden, Individuals Interactive Home/ Duration, Greater than or No internet access Usual care Usual care 0
200427 interested consumer residence Baseline equal to 40 years plus web-
in their own website collected old, based nutrition
health care between Diabetes mellitus counseling and
September type 2, social support
2002 to Hypertension, program
December Dyslipidemia
2002 with 8
month follow
up
Wylie- Individuals Computerized Kiosk NS BMI > 25 kg/m2+ Intention to move Work book Computer
Rosett, (BMI > 25 tailoring based one beyond commuting only tailored
200128 kg/m2) in a cardiovascular risk distance feedback;
freestandin factor computer
g health tailored
maintenan feedback plus
ce staff
organizatio consultation
n
Eating disorder
Winzelberg, Individuals Interactive Home/ NS (F), West coast History of Bulimia No Interactive 0
200029 interested consumer residence public university or anorexia, intervention consumer web
in their own website students currently engaged site
health care Desire to improve in purging activities,
body image BMI below 18
satisfaction
Nutrition intervention
Bruge, Individuals Interactive NS NS Employees of Non-tailored Tailored group; 2
199630 interested consumer Royal Shell group; computer
in their own website laboratory in general generated
health care Amsterdam, nutrition feedback
Netherlands information letters
G-41
Year data
Silk, 200831 Individuals Interactive Home/ 2 weeks 18-50 years, Pamphlet Website 0
interested consumer residence, (F), one or more
in their own website children or Video Game
health care Remote pregnant, poverty
location: (yearly income
Mothers or communit less than or equal
pregnant y agency to 185% of the
or federal poverty
extension index
service
office
Jones, Individuals Interactive NS 2005; 16 >85th percentile Wait list SB2-BED 1
32
2008 interested consumer weeks for age-adjusted control
in their own website BMI, group
health care binge eating or
overeating
behaviors at a
frequency of >1
times per week in
the previous 3
months,
access to a
computer and the
Internet,
not currently
enrolled in a
formal binge
eating or weight
loss program (eg,
Weight Watchers),
absence of any
medical condition
in which the actual
condition or
treatment affects
weight and/or
appetite,
absence of
anorexia nervosa
G-42
Year data
and bulimia
nervosa
NS = not specified, yr = year
Reference List
56.
5 Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: The effectiveness of tailored messages in
primary care settings. 1994; 84(5):783-7.
G-43
2000; 31(4):380-9.
Disord 2006; 14(1):17-30.
2003; 25(2):92-9.
Health Educ Res 2007; 22(3):385-96.
29(1):54-63.
G-44
Psychol 2000; 68(2):346-50.
G-45
Evidence Table 9. Description of consumer characteristics in RCTs addressing KQ 1b (impact of CHI applications on intermediate outcomes)
Control Marital
Author, Race, Gender, n Status,
year Interventions Age n(%) Income Education, n(%) SES (%) n(%) Other
diet/exercise/physical activity NOT obesity
Adachi, Control Mean, 46.3 NS NS NS NR Height (cm):
1
2007 SD, 8.6 mean, 157.6
SD, 5.9
Body weight (kg):
mean, 65.1
SD, 6.4
BMI (kg/m2):
mean, 26.1
SD, 1.6
Behavioral Mean, 46.6 NS NS NS NR Height:
weight control SD, 10.1 mean, 157.5
program with SD, 6.1
6-month weight Body weight (kg):
and targeted mean, 65.3
behavior’s self- SD, 6.4
monitoring BMI (kg/m2):
mean, 26.2
SD, 1.4
Untailored self- Mean, 46.6 NS NS NS NR Height:
help booklet SD, 9 mean, 155.7
with 7-month SD, 5.2
self monitoring Body weight (kg):
mean, 63.4 SD, 5.5
BMI (kg/m2):
mean, 26.1
SD, 1.5
Behavioral Mean, 45.3 NS NS NS NR Height:
weight control SD, 10.4 mean, 157.0
program SD, 5.5
Body weight (kg):
mean, 64.8
SD, 6.5
BMI (kg/m2):
mean 26. SD, 1.5
Anderson, Control NS NS NS NS NS NS
20012 Intervention NS NS NS NS NS NS
Sample NS White (92) Median Mean years of NS F (96) .70 children (SD
statistics annual education 1.00, p<.001)
G-46
Evidence Table 9. Description of consumer characteristics in RCTs addressing KQ 1b (impact of CHI applications on intermediate outcomes) (continued)
Control Marital
$35,000; 14.78±2.11; 12
$20,000 years or fewer (20)
or less
(12)
Brug, Control- NS NS NS NS NS NS NS
3
1998 General
Information
Tailored NS NS NS NS NS NS NS
Feedback;
Tailored +
Iterative
Feedback
Baseline 44 (SD 14) NS NS College degree NS F (82) Mean body mass
Statistics years. (42) index was 23.7 (SD
5.9) for women
and 24.6 (SD 3.7) for
men.; mean fat
score at baseline
was 27.2 (SD 5.2);
mean number of
daily servings of
vegetables and fruit
were 1.0 (SD 0.4)
and 2.2 (SD 1.7),
respectively. Mean
attitude scores at
baseline (on a -3 to
3 scale) were 2.0
(SD 1.4)
toward fat reduction
and 2.5 (SD 0.8) and
2.3'(SD 0.9) toward
increasing
vegetables and fruit.
Self-efficacy (range -
3 to 3) expectations
were 0.6 (SD 1.8),
1.3 (SD 1.7), and 1.2
(SD 1.9) toward
reducing fat and
G-47
Control Marital
increasing
vegetables and fruit,
respectively.
Brug, Comparison M 41.3 NS NS NS NS NS BMI 23.9
19994 163
Experimental M 38.6 NS NS NS NS NS BMI 24.2
152
Campbell, No messages NS NS NS NS NS NS NS
5
1994 (124)
Tailored NS NS NS NS NS NS NS
messages
(134)
Non-tailored NS NS NS NS NS NS NS
messages
(136)
Baseline Average Minority Median (mean 13.6 years), NS F (75.3) NS
characteristics age of 40.8 enrollment annual
years (19.0) househol
d level
was
$30 000
to $39
000,
Campbell, Control 212 28.9 (0.59) Caucasian NS Less than high NS NS Mean child number
6
1999 10.8 school (33.0) (SE) 2.1 (0.09)
African- high school High autonomy
American graduate or GED ( (71.2)
82.1 36.3) Feel need to lose
Hispanic beyond high school weight (62.3)
1.9 (30.7)
American
Indian 1.9
other
ethnicity 3.3
Intervention 30.2 (0.67) Caucasian NS Less than high NS NS Mean child number
165 7.3 school (33.9) (SE) 2.2 (0.10)
African- High school High autonomy
American graduate or GED (77.0)
87.3 (37.0) Feel need to lose
Hispanic beyond high school weight (59.4)
G-48
Control Marital
1.2 (29.1)
American
Indian 0.6
other
ethnicity 3.6
Campbell, Control-No 27.5 (8.6) African NS High school 17.1; NS F(97) Pregnant (19),
20047 intervention American High school or Breast-feeding (5);
(166) 26.7; White GED 67.1; Beyond Number of children,
non- high school mean (SD) 2.0 (1.1)
Hispanic (any trade/beauty
60.6; Other school/college)
12.7 15.8
Computer 27.3 (7.9) African NS High school 21.3; NS F(98) Pregnant (23);
tailored American High school or Breast-feeding (4)
interactive 39.7; White GED 66.7; Beyond Number of children,
nutrition non- high school mean (SD) 1.9 (1.0)
education Hispanic (any trade/beauty
(141) 48.9; Other school/college)
12.7 12.0
Haerens, Control 12.85 (0.71) NS NS NS Lower Girls NS
20058 condition (n 5 SES (58.8)
schools, 759 (52.4)
pupils)
Intervention 13.04 (0.79) NS NS NS Lower Girls NS
with parental SES (40.1)
support (68.0)
(n schools,
1226 pupils)
Intervention 13.24 (0.87) NS NS NS Lower Girls NS
alone (n 5 SES (15.6)
schools, 1006 (78.9)
pupils)
Haerens, No intervention Mean, 13.2 NS NS General, 84 (55.6) NR F,111 Stage of change:
9
2007 SD, 0.5 Technical- (73.5) Pre-contemplation,
G-49
Control Marital
vocational, 67 M,40 36 (24.8)
(44.4) (26.5) Contemplation,
8 (5.5)
Preparation, 12 (8.3)
Action, 34 (23.4)
Maintenance,
55 (37.9)
Dietary fat intake:
mean, 113.9
SD, 46.3
Intervention Mean, 13.3 NS NS General, 90 (58.8) NR F,103 Stage of change:
SD, 0.5 Technical- (67.3) Pre-contemplation,
vocational, 63 M, 50 42 (28.2)
(41.2) (32.7) Contemplation,
4 (2.7)
Preparation ,11 (7.4)
Action, 44 (29.5)
Maintenance, 48
(32.2)
Dietary fat intake:
mean, 116.3
SD, 50.1
Haerens, Control- NS NS NS NS NS NS NS
10
2009 Generic
feedback
information
Computer NS NS NS NS NS NS NS
tailored feed
back
Baseline 14.6 _ (1.2) NS NS NS NS (526 NS
Characteristics boys, 645
girls
Hurling, Control 22 M 34.9 NS NS NS NS F 78 NS

11
2006 Intervention 25 M 34.0 NS NS NS NS F72 NS
Hurling, No intervention Mean, 40.1 White non- NS NS NR F, (70) Household
12
2007 SD, 7.7 Hispanic, broadband access:
(97) yes, (22)
Weight in kg:
mean, 73.9
G-50
Control Marital
SD, 10.2
BMI:
mean, 26.5
SD, 4.1
Initial IPAQ
self0report level of
physical activity
(MET min):
mean, 3868
SD, 2257
Internet and Mean, 40.5 White non- NS NS NR F (64) Household
mobile phone SD, 7.1 Hispanic, broadband access:
intervention (100) Yes, (29)
Weight in kg:
mean, 75.1
SD, 11.7
BMI:
mean, 166.3
SD, 6.6
Initial IPAQ
self0report level of
physical activity
(MET min):
mean, 4350
SD, 3200
King, Generic health 61.0 (11.0) Hispanic Income Completed high NS F(51.3) Married (63.7);
200613 risk appraisal (8.2) White Less school (27.4) Taking insulin (19.1);
CD-ROM (79.1) than Technical school Body mass index
$10,000 (37.6) (kg/m2) (M, SD))
5.3 Completed college 31.9 (7.2);
$10,000 (22.9) Comorbiditiesd (M,
to Graduate degree SD) 3.1 (2.1);
$29,999 (12.1) Smokers 11.9
20.0
$30,000
to
$49,999
35.3
$50,000
to
G-51
Control Marital
$69,999
18.7
$70,000
to
$89,999
12.0
$90,000
or more
11.9
Interactive 61.9 (11.7) Hispanic Income Completed high NS F(50.0) Married (67.8);
CD-ROM (17.4) White Less school (27.4) Taking insulin (24.7);
(74.3) than Technical school Body mass index
$10,000 (37.6) (kg/m2) (M, SD) 31.4
4.8 Completed college (7.0) ;
$10,000 (22.9) Comorbiditiesd (M,
to Graduate degree SD) 2.9 (1.9) ;
$29,999 (12.1) Smokers (8.2)
24.8
$30,000
to
$49,999
27.0
$50,000
to
$69,999
20.0
$70,000
to
$89,999
9.7
$90,000
or more
8.2
Kristal, Usual Care NS NS NS NS NS NS NS
14
2000 (730)
Intervention NS NS NS NS NS NS NS
(729)
Base line 44.9 ± 14.9 White 85.9; (%, NS NS M (50.9) Body mass index (x
characteristics Black 4.5; $1,000), 6 SD) 26.5 6 5.0
Asian 5.8; <25
G-52
Control Marital
Hispanic (12.2);
3.0; Other 25–34
0.8 16.9;
35–49
25.4;
50–69
23.7;
701 21.7
Lewis, Standard NS NS NS NS NS NS NS
200815 Internet
Motivationally- NS NS NS NS NS NS NS
Tailored
Internet
Baseline NS Caucasian NS NS NS Women NS
Statistics (76.3) (82.7)
Low, Control NS Students of NS NS NR NS
16
2006 color (8.4)
Student bodies NS NS NS NS NR F (100) NS
with a
moderated
discussion
Student bodies NS NS NS NS NR F (100) NS
with a un-
moderated
discussion
Mangunkusu Internet Mean, 15 Dutch, NS NS NR M, (43.9) Lower
mo, range, 13- (76.5) secondary/vocationa
200717 17 Turkish l, (59.1)
(5.0) Int. secondary,
Moroccan (18.6)
(3.3) Upper secondary,
Surinamese (22.3)
(2.4)
Antillean/Ar
ubans (0.4)
Other (12.3)
Control NS NS NS NS NR NS NS
Marcus, Control 46.3 (9.4) NS NS NS NR NS
18
2007 Tailored print Mean, 445 White non- USD College graduate NR F, (83.7) Married, BMI:
G-53
Control Marital
SD, 9.6 Hispanic, >50,000, (or doing post (69.8) mean, 29.1
(77.9) (57.0) graduate work), SD, 6.2
(72.1) Employment:
employed, (80.2)
Tailored Mean, 44.5 White non- USD College graduate NR F, (81.5) Married, BMI:
internet SD, 9 Hispanic, >50,000, (or doing post (63.0) mean, 29.7
(82.7) (58.0) graduate work), SD, 6.5
(64.2) Employment:
employed, (90.0)
Control 46.3 (9.4 White non- USD College graduate NR F, (82.9) Married, BMI:
Hispanic, >50,000, (or doing post (55.6) mean, 29.5
(84.1) (53.7) graduate work), SD, 5.5
(64.6) Employment status:
employed, (89.0)
Napolitano, Wait list control NS NS NS NS NR NS
19
2003 group
Internet NS NS NS NS NR NS
Oenema, Non-tailored NS NS NS NS NR NS
20
2001 nutrition
information
letter
Web based NS NS NS NS NR NS
tailored
nutrition
education
Richardson, Lifestyle Goals 52 ± 12 White (76), <30,000 HS diploma or GED NS M (29) Baseline Average
200721 (LG) Group Black (18), (18), (6), Some college F(71) Daily Step Count
(17) Other (6) 30,000- (47), College 4,157 ± 1,737;
70,000 degree (18), Baseline BMI 38.6 ±
(18), Graduate degree 8.2.; Baseline Blood
>70,000( (29) Pressure
65) Systolic 133 ± 18,
Diastolic 80 ± 9; On
Insulin
No (88), Yes (12);
Internet Usage
(Home)
Never (6), ≤ 4 times
per month (12),
G-54
Control Marital
Several times a
week (12),Almost
every day (65)
Structured 53 ± 9 White (77), <30,000( HS diploma or GED NS M (38) Baseline Average
Goals (SG) Black (8), 8), (8), Some college F(62) Daily Step Count
Group (13) Other (15) 30,000- (15), College 5,171 ± 1,769;
70,000 degree (46), Baseline BMI 35.3 ±
(31), Graduate degree 8.6.; Baseline Blood
>70,000 (31) Pressure
(62) Systolic 136 ± 12,
Diastolic 82 ± 11;
On Insulin
No (69), Yes (31);
Internet Usage
(Home)
Never (23), ≤ 4 times
per month (8),
Several times a
week (23),Almost
every day (46)
Smeets, Control group Range, 18- NS NS Primary or basic NR F (57) NS
22
2007 receiving one 65 vocational
general Mean, 47 school(10),
information SD, 11 Secondary
letter vocational level or
high school degree
(42),
Higher vocational
school, college
degree, or
university
degree(48)
Computer NS NS NS NS NR NS NS
generated
tailored
newsletter
Spittaels, No Intervention Age in years NS NS Higher education NS F(66.7) Employed 87.8;
200723 40.7 (5.3) 72.7 Compliance with PA
recommendations
37.9; Stages of change
G-55
Control Marital
Precontemplation 6.1
Contemplation 19.8
Preparation 36.6
Action 8.4
Maintenance 29.0;
BMI in kg/m2 24.1
(3.5);
PA at moderate
intensity in min/day
30.9 (36.4)
Website with Age in years NS NS Higher education NS F (65.3) Employed 86.2 ;
computer 43.3 (5.7) 61.9 Compliance with PA
tailored recommendations
feedback 47.4; Stages of change
Contemplation 8.7
Preparation 40.5
Action 11.6
Maintenance 35.8;
BMI in kg/m2 25.0
(3.7);
PA at moderate
40.9 (40.5)
Website without Age in years NS NS Higher education NS F (66.7) Employed 84.5 ;
computer 39.6 (5.0) 67.4 Compliance with PA
tailored recommendations 44.2
feedback ; Stages of change
Contemplation 15.5
Preparation 34.1
Action 12.4
Maintenance 31.8 ;
BMI in kg/m2 24.6
(3.6) ;
PA at moderate
39.5 (42.3)
Spittaels, Standard Range, NS NS College or NR F (27) BMI:
24
2007 advice 25-55 university mean, 24.4
G-56
Control Marital
mean, 40.9 degree(59.6) SD, 3.1
SD, 8 Work status:
Factory workers (22)
Office workers (51)
Managers (27)
Stages of Change:
Pre-contemplation
(10.7)
Contemplation (17.9)
Preparation (10.7)
Action (10.0)
Maintenance (49.3)
Tailored advice Range, NS NS College or NR F (38.8) BMI:
+ email 5-55 university mean, 24.3
mean, 39.7 degree(63.4 ) SD, 3
SD, 8.9 Work status:
Factory workers
(22.4)
Office workers (60.3)
Managers (17.2)
Stages of Change:
Pre-contemplation
(6.9)
Preparation (11.2)
Action (12.9)
Maintenance (55.2)
Tailored advice Range, 25- NS NS College or NR F (32) BMI:
55 university mean, 24.4
mean, 39.3 degree(68.9) SD, 3.5
SD, 8.7 Work status:
Factory workers
(21.3)
Office workers (51.6)
Managers (27.0)
Stages of Change:
Pre-contemplation
(7.6)
Preparation (10.1)
G-57
Control Marital
Action (16.0)
Maintenance (52.9)
Tan, 200525 No information NS NS NS NS NR NS
Tailored NS NS NS NS NR NS
Information
Tate, 200626 No counseling Mean, 49.9 Minority NS College NR F: 55, (82) 49 (73) Weight:
SD, 8.3 6(9) graduate(49) mean, 88.3 (13.9)
body mass index:
32.3 (3.7)
internet experiences,
y: 4.7 (2.9)
Waist circumference,
cm: 106.4 (11.3)
Weekly internet use,
h: 4.5 (4.9)
Human email Mean, 47.9 Minority NS College NR F: 54,( 84) 53(83) Weight: mean, 89.0
counseling SD, 11.4 8(13) graduate(56) (13.0)
body mass index:
32.8 (3.4)
internet experiences,
y: 4.1 (2.3)
cm: 107.4 (10.8)
h: 4.7 (5.3)
Automated Mean, 47.9 Minority NS College graduate NR F: 53,( 87) 46(75) Weight:
feedback SD, 9.8 6(10) (59) mean, 89.0 (13.2)
body mass index:
32.7 (3.5)
internet
experiences, y:
4.4 (2.2)
cm: 107.6 (11.2)
h: 5.0 (4.2)
Vandelanotte Control NS NS NS NS NR NS NS
27
, 2005 Sequential NS NS NS NS NR NS NS
Interactive
computer
G-58
Control Marital
tailored
intervention
Simultaneous NS NS NS NS NR NS NS
interactive
computer
tailored
intervention
Verheijden, Usual care Mean, 64 NS NS < High school13 NR M: 43 (59) Lifestyle:
200428 SD, 10 (18) , F: 30 (41) Never smoke:28 (39)
Intermediate22 Ex-smoker: 38 (52)
(30), Current smoker: 7
>B.Sc. level38 (52) (9)
Alcohol >3
glasses/wk: 39 (54)
mean,
Exercise >3
times/wk: 45 (61)
Medication use:
HTN: 49 (67)
Dyslipidemia:23 (31)
DM type 2: 13 (18)
Stage of Change:
Pre-contemplation:
12 (16)
Contemplation: 4 (5)
Preparation: 5 (7)
Action: 3 (4) mean
Maintenance: 50
(68)
Web-Based Mean, 62 NS NS < High school 15 NR M: 38 (52) Lifestyle:

Targeted SD, 11 (21), Intermediate F: 35 (48) Never smoker: 26
Nutrition 31 (42), (35)
Counseling >B.Sc. level27 (37) Ex-smoker: 37 (51)
and Social Current smoker: 10
Support (14)
Alcohol>3
glasses/wk: 41 (56)
mean, Exercise>3
wks/wk: 46 (63)
G-59
Control Marital
Medication use:
HTN: 49 (67)
Dyslipidemia: 26
(35)
DM type 2: 9(13)
Stage of change:
Pre-contemplation:
11 (15)
Contemplation: 2 (3)
Preparation: 7 (1)
Action: 9 (13)
mean, Maintenance:
50 (68)
Wylie-Rosett, Work book 52.5± 11.50 White NS Education>1 yr in NS F 88 NS

200129 only 100(86.2) college 99 (85.3) (75.7)
Computer 52.7± 11.27 White 195 NS Education>1 yr in NS F 199 NS

tailored (82.6) college 193 (81.8) (84.3)
feedback
computer 51.6± 12.14 White 193 NS Education>1 yr in NS F 197 NS
tailored (81.8) college 192 (85.6) (83.5)
feedback plus
staff
consultation
Eating disorder
Bruge, Non-tailored Mean, 39 NS NS NR M (83) Fat
30
1996 group SD, 8 University training consumption/day:
(34) 28.0(5.3)
Technical degree Vegetable
(59) servings/day: 1.00
Less than high (0.31)
school (7) Fruit servings/day:
1.61(1.14)
Intervention NS NS NS NS NR NS NS
group
Silk, 200831 Video game Mean, 33, European Yearly NR F (100) NS
SD, 8.28 American income Less than college
(68) less or (87)
G-60
Control Marital
African equal to High school or
American (185) of GED equivalent
(25) federal (44)
Latino (5) index:
Asian (1) (100)
Other (1)
Web site NS NS NS NS NR NS NS
Define NS NS NS NS NR NS NS
Winzelberg, No intervention Mean, 20 White non- NS NS NR F (100) NS
200032 range, 18- Hispanic,
33 (53)
SD, 2.8 Black non-
Hispanic,
(3)
Latino/Hisp
anic, (35)
API, (5)
Other, (3)
Intervention NS NS NS NS NR NS NS
Jones, Wait list control Mean, 15.2 White non- NS Grade in school, n: NR F, 35 Born in United
33
2008 group SD, 1.1 Hispanic, 9th, 20 M, 18 States (92)
32 10th, 19 BMI: mean, 30.64
Black non- 11th, 13 SD, 5.97
Hispanic, 6 12th, 1
Latino/Hisp
anic, 10
API,
Other, 5
SB2-BED Mean, 15 White non- NS Grade in school, n: NR F, 38 Born in United
SD, 1 Hispanic, 9th 26 M, 14 States :(96)
35 10th 16 BMI: mean, 30.58
Black non- 11th 10 SD, 4.9
Hispanic, 2 12th 0
Latino/Hisp
anic, 12
Other, 3
NR= Not Reported, NS= Not Specified, SD= Standard Deviation, SES= Socioeconomic Status, Yr= year, CBT= Cognitive Behavioral Therapy, WL= Wait List,
BMI= Body Mass Index, QOL= Quality of Life, USD= United States Dollars, Female = F, Male = M, AIAN = American Indian/Alaska Native
G-61
Reference List
56.
5 Dickerson S, Reinhart AM, Feeley TH et al. Patient Internet use for health information at three urban primary care clinics. J Am Med Inform Assoc 2004;
11(6):499-504.
G-62
2000; 31(4):380-9.
Disord 2006; 14(1):17-30.
2003; 25(2):92-9.
Health Educ Res 2007; 22(3):385-96.
29(1):54-63.
G-63
Psychol 2000; 68(2):346-50.
G-64

Impact of Consumer Health Informatics Applications

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Evidence Report/Technology Assessment

Impact of Consumer Health Informatics Applications

Contract No. HHSA 290-2007-120061-I

AHRQ Publication No. 09(10)-E019

No investigators have any affiliations or financial involvement (e.g., employment,

Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H.

Beth A. Collins Sharp, R.N., Ph.D. Teresa Zayas-Cabán, Ph.D.

Evidence Report ...........................................................................................................................11

Chapter 1. Introduction .................................................................................................................13

Chapter 3. Results ..........................................................................................................................23

Chapter 4. Discussion ....................................................................................................................97

References and Included Studies .................................................................................................103

The specific Key Questions were:

1. What evidence exists that CHI applications impact:

Key Question 1: What is the evidence of impact of CHI applications

Key Question 2: What are the barriers that clinicians, developers,

Key Question 3: What knowledge or evidence deficits exist regarding

Key Question 4: What critical information regarding the impact of

Consumer Health Informatics

Purpose of Evidence Report

Recruitment of Technical Experts and Peer Reviewers

Literature Search Methods

Search Terms and Strategies

Organization and Tracking of the Literature Search

Data Entry and Quality Control

Reasons for Exclusion at Article Review Level*

Figure 2. Summary of literature search (number of articles)

Key Question 1a: What evidence exists that consumer health

Strengths and Limitations of the Evidence

General Study Characteristics

Target N Author, year Interventions Primary outcomes measured Effect of CHI

Strengths and Limitations of the Evidence

Target Effect of CHI

Diet, Exercise, Physical Activity, not Obesity

Target Effect of CHI

Positive attitude to increasing +

Target Effect of CHI

Total self-efficacy score 0

Haerens, CD-ROM Fat intake (g/day, day 21) 0

Target Effect of CHI

Target Effect of CHI

Target Effect of CHI

General Study Characteristics

Strengths and Limitations of the Evidence

General Study Characteristics

Target Effect of CHI

Target Effect of CHI

Target Effect of CHI

Alcohol abuse. Riper et al58 investigated the effects of a Web-based, multi-component,

Strengths and Limitations of the Evidence

General Study Characteristics

Target Effect of CHI

Target Effect of CHI

Strengths and Limitations of the Evidence

General Study Characteristics

Target Effect of CHI

Eight studies evaluated the impact of CHI applications on intermediate outcomes in

Target Effect of CHI

Proudfoot, Computerized Depression (BDI) +

Strengths and Limitations of the Evidence

General Study Characteristics

Asthma and Chronic Obstructive Pulmonary Disease

Strengths and Limitations of the Evidence

Target Effect of CHI